alpha-chymotrypsin and Chronic-Disease

Topics: Amylases; Chronic Disease; Chymotrypsin; Duodenum; Feedback; Humans; Lipase; Pancreas; Pancreatic Function Tests; Pancreatitis; Trypsin

Topics: Animals; Cholecystokinin; Chronic Disease; Chymotrypsin; Enzyme Therapy; Exocrine Pancreatic Insufficiency; Feedback; Female; Humans; Male; Pain; Pancreas; Pancreatitis; Rats; Trypsin

To establish the diagnosis of acute pancreatitis the estimation of amylase in serum and urine, lipase and radio-immunoreactive trypsin in the serum are useful. Lipase estimations are more helpful than measuring amylase values. Trypsin-RIA-tests are increasingly important adults. But in chronic pancreatitis and inborn secretory insufficiencies of the pancreas these methods are less helpful. PABA-test, pancreolauryl-test (PLT), and the estimation of chymotrypsin in faeces are screening procedures, although their results correlate well amongst each other. As compared to the chymotrypsin estimation in faeces PABA test and PLT allow for some semiquantitative estimation of the secretory function and dynamics of the gland. The influence of malabsorption, liver and kidney diseases on these parameters is not yet quite clarified. Besides screening they are undoubtedly of value for judging the course and therapy of cystic fibrosis, Shwachman-syndrome, iatrogenic lesions by cytostatics (immunosuppressives and corticosteroids). Quantitative estimations of fat in faces and the pancreozymin test are no longer of significance.

Topics: 4-Aminobenzoic Acid; Acute Disease; Aminobenzoates; Amylases; Child; Child, Preschool; Chronic Disease; Chymotrypsin; Cystic Fibrosis; Exocrine Pancreatic Insufficiency; Feces; Humans; Infant; Lipase; Pancreatic Function Tests; Pancreatitis; Trypsin

Topics: 4-Aminobenzoic Acid; Acute Disease; Chronic Disease; Chymotrypsin; Feces; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Pancreatitis; Prognosis; Recurrence; Virus Diseases; Wounds and Injuries

Topics: Animals; Calcinosis; Chronic Disease; Chymotrypsin; Humans; Pancreatic Juice; Pancreatitis; Proteins; Rats

Topics: Animals; Anterior Chamber; Cataract; Chronic Disease; Chymotrypsin; Ciliary Body; Cortisone; Glaucoma; Humans; Intraocular Pressure; Microscopy, Electron; Rats

Topics: Animals; Burns; Chronic Disease; Chymotrypsin; Diabetic Angiopathies; Gangrene; Humans; Injections, Intramuscular; Injections, Intravenous; Leg Ulcer; Peptide Hydrolases; Preoperative Care; Skin Ulcer; Trypsin

Chronic obstructive parotitis (COP) is a common disease of the parotid gland. A total of 104 patients with COP were identified and randomized into a treatment group (52 cases) and a control group (52 cases). All patients underwent sialography and salivary gland scintigraphy (SGS) examinations before surgery. The patients in the treatment group received chymotrypsin combined with gentamicin via interventional sialendoscopy to irrigate the duct, and the control group received gentamicin alone. All patients were asked to record their pain on a visual analogue scale (VAS) before treatment and at 1 week, 2 weeks, 1 month, 3 months, and 6 months after surgery. The VAS score for pain intensity was decreased at 1 week post-treatment in both groups (P<0.05). Compared to the control group, the VAS score was lower in the treatment group at 1 week, 2 weeks, and 1 month post-treatment (P<0.05). The 6-month postoperative SGS results showed improved uptake and excretion in both groups (P<0.05). The treatment group exhibited higher scores for postoperative SGS excretion than the control group (P<0.05). The administration of chymotrypsin combined with gentamicin by sialendoscopy is effective for the treatment of non-stone-related COP and specifically improves the excretion function of the parotid gland.

Topics: Adult; Aged; Anti-Bacterial Agents; Chronic Disease; Chymotrypsin; Combined Modality Therapy; Endoscopy; Gentamicins; Humans; Middle Aged; Pain Measurement; Parotitis; Sialography; Treatment Outcome

To evaluate changes on venous diameter and perimeter of lower limbs in chronic venous disorder (CVD) patients after different clinical treatments for four weeks.. Fifty-two female patients classified as C2,s or C2,3,s (CEAP classification) were allocated consecutively in three groups: Cirkan (40 mg of the root extract of Ruscus aculeatus + 100 mg of flavonoid hesperidine methylchalcone + 200 mg of vitamin C per pill); elastic compression stockings (ECS) and no treatment (NT). Diameters were determined by duplex ultrasound and perimeter with Leg-O-Meter.. After treatment, Cirkan significantly decreased popliteal vein and great saphenous vein (GSV) diameters bilaterally and ECS decreased popliteal vein diameter bilaterally and GSV and varices only on the left limb. Perimeters changed only with ECS. Clinical scores changed between Cirkan x NT and ECS x Cirkan. Disability score varied for ECS x NT and Cirkan x NT. chi2 test detected different distribution frequency for C3 and C2 classes according to treatment: ECS (both limbs) and Cirkan (only left limb). Varices and anatomical scores did not change.. ECS emerges as the most effective clinical treatment tested but improvements with Cirkan on vein diameter and CEAP class were also observed. Clinical scores improved due to pain relief and edema reduction (ECS). These findings point to a positive effect of Cirkan, suggesting that venotonic drugs should be taken into account in the treatment of CVD.

Topics: Adult; Anthropometry; Ascorbic Acid; Brazil; Cardiovascular Agents; Chi-Square Distribution; Chronic Disease; Chymotrypsin; Disability Evaluation; Drug Combinations; Female; Hesperidin; Humans; Lower Extremity; Middle Aged; Pain; Pain Measurement; Phytosterols; Popliteal Vein; Saphenous Vein; Stockings, Compression; Time Factors; Treatment Outcome; Trypsin; Ultrasonography, Doppler, Duplex; Vascular Diseases

Glycogen storage disease type I (GSD I) (McKusick 232200) is caused by inherited defects of the glucose-6-phosphatase complex. Patients with GSD Ia as well as patients with GSD lb may suffer from intermittent diarrhoea, which seems to worsen with age. The cause of this diarrhoea is unknown. This study describes the results of investigations of intestinal functions and morphology in patients with GSD Ia and GSD lb, which were performed to detect a common cause for chronic diarrhoea in GSD I. The following were investigated: faecal fat excretion, faecal alpha1-antitrypsin and faecal chymotrypsin, expiratory H2 concentrations, persorption of cornstarch in urine and colonic biopsies. With the investigations presented in this study, no common cause for diarrhoea in GSD I was found. In GSD lb loss of mucosal barrier function due to inflammation, documented by increased faecal alpha1-antitrypsin excretion (3.5-9.6 mg/g dry faeces) and inflammation in the colonic biopsies, seems to be the main cause. The inflammation is most likely related to disturbed neutrophil function, which is often found in GSD lb. Whether another cause is involved in GSD Ia and in GSD Ib, related to the disturbed function of glucose-6-phosphatase in the enterocyte, remains to be investigated.

Topics: Adolescent; Adult; alpha 1-Antitrypsin; Child; Child, Preschool; Chronic Disease; Chymotrypsin; Colon; Diarrhea; Dietary Fats; Feces; Female; Glycogen Storage Disease Type I; Humans; Hydrogen; Infant; Intestinal Absorption; Intestines; Male; Starch

In the examination of 64 patients with chronic obstructive bronchitis, some specificities of functioning of decompensation mechanisms in the glutathione antiradical system were established as were changes in morphofunctional and receptor properties of erythrocytes in chronic obstructive bronchitis. The patients were shown to have derived benefit from a combined treatment involving the use of the enzymic drug preparation Wobe-Mugos E which was found to make for improvement of rheological properties of erythrocytes, their capability of depositing and transporting catecholamines.

Topics: Adult; Bronchitis; Catecholamines; Chronic Disease; Chymotrypsin; Drug Combinations; Erythrocytes; Free Radicals; Glutathione; Humans; Malondialdehyde; Middle Aged; Pancreatic Extracts; Papain; Rheology; Thymus Extracts; Trypsin

The diagnosis of chronic pancreatitis usually is based on imaging studies, pancreatic function tests, and the presence of characteristic clinical features. In Japan, diagnostic criteria for chronic pancreatitis were established in 1983 and revised in 1995. Under the new criteria, the secretin test (a duodenal intubation test) and the combination of noninvasive tests, N-benzoyl-L-tyrosyl-p-aminobenzoic acid (BT-PABA) and fecal chymotrypsin (FCT), have been recommended for evaluating exocrine pancreatic function in patients with chronic pancreatitis. In the present study, the diagnostic value of these two noninvasive tests was compared to the secretin test. Although noninvasive tests are less sensitive and specific for determining exocrine pancreatic impairment than the secretin test, greater reliability for diagnosing chronic pancreatitis can be obtained by performing the BT-PABA and fecal chymotrypsin tests simultaneously. Combining BT-PABA and FCT is easy and useful and should be performed at least twice to obtain reliable results.

Topics: 4-Aminobenzoic Acid; Chronic Disease; Chymotrypsin; Duodenum; Feces; Female; Humans; Intubation, Gastrointestinal; Male; Pancreatic Function Tests; Pancreatitis; para-Aminobenzoates; Secretin; Sensitivity and Specificity

To evaluate the effectiveness of exocrine function tests in diagnosing chronic pancreatitis (CP), we compared the sensitivity and specificity of duodenal intubation with tubeless tests. While the secretin test (ST) was necessary to diagnose CP, especially in noncalcified CP, and tubeless tests demonstrated insufficient sensitivity to diagnose CP, the combination assay of tubeless tests was specific enough to diagnose severe exocrine dysfunction. Our studies found the sensitivity of secretin testing to diagnose definite CP to be 87%. In patients with probable CP, 60% had mild exocrine insufficiency and 40% had normal function. The false-positive rate of the ST results in nonpancreatic diseases, except diabetes mellitus, was 5%. The correlation between morphological changes in endoscopic retrograde pancreatography (ERP) and exocrine function evaluated by ST was 74%. In patients with calcified CP, 81% had parallel results between ERP and the ST, but in noncalcified CP, 47% had parallel results. In patients with severe or moderate exocrine insufficiency demonstrated by ST, abnormally low levels were observed in 63% by N-benzoyl-L-tyrosyl-p-aminobenzoic acid (BT-PABA) test, 61% by fecal chymotrypsin test (FCT), and 44% by pancreatic amylase (PA). In patients with normal exocrine function demonstrated by ST, abnormally low levels were observed in 28% by BT-PABA test, 28% by FCT, and 10% by PA. A combination assay of BT-PABA test, FCT, and PA improved the specificity for diagnosing CP but not the sensitivity.

Topics: 4-Aminobenzoic Acid; Amylases; Cholangiopancreatography, Endoscopic Retrograde; Chronic Disease; Chymotrypsin; Feces; Humans; Isoamylase; Pancreas; Pancreatic Function Tests; Pancreatitis; para-Aminobenzoates; Phospholipases A; Secretin; Sensitivity and Specificity; Severity of Illness Index; Tomography, X-Ray Computed; Trypsin; Ultrasonography

The chymotrypsin in the stool test was used to monitor adequate enzymatic substitution in treating exocrine pancreatic insufficiency with 18 patients (16 suffering from chronic pancreatitis and 2 having passed duodenopancreatectomy due to pancreatic cancer). This test helps to identify pancreatic insufficiency and can be successfully used in monitoring the adequate amount of pancreatic substitute, which, we have found, differs from patient to patient. The dosage can be higher in cases of chronic pancreatitis than in those required after duodenopancreatectomy.

Topics: Amylases; Chronic Disease; Chymotrypsin; Drug Monitoring; Endopeptidases; Feces; Humans; Lipase; Pancreatic Neoplasms; Pancreaticoduodenectomy; Pancreatin; Pancreatitis

Twelve patients with chronic pancreatitis underwent a pancreatoduodenectomy in which the pylorus was preserved. The effects of parenteral and enteral nutrition on pancreatic secretion were compared. Postoperative nutrition was administered by needle-catheter jejunostomy in seven patients and by total parenteral nutrition in five patients. Pancreatic juice, drained directly from the pancreatic duct, was collected in 4-hour fractions. Volume, bicarbonate, protein, amylase, and chymotrypsin were measured. In the first two postoperative days, there was a slow increase in all measured indices. On the third postoperative day, an abrupt rise occurred, after which pancreatic secretion stabilized. No differences in exocrine pancreatic secretion were observed between the enteral and parenteral methods of feeding.

Topics: Adult; Amylases; Bicarbonates; Chronic Disease; Chymotrypsin; Duodenum; Enteral Nutrition; Female; Humans; Male; Middle Aged; Pancreas; Pancreatic Juice; Pancreatitis; Proteins

In order to determine whether the doses of cerulein generally used in the secretin-cerulein test are supramaximal, the pancreatic secretion of enzymes and bicarbonate in response to intravenous infusion of cerulein plus secretin was studied in 6 subjects on two separate days at the respective doses of 50 ng/kg/h and 0.5 CU/kg/h on one day, and 100 ng/kg/h and 1 CU/kg/h on the other. In all subjects studied, the infusion of cerulein at the dose of 100 ng/kg/h caused a pancreatic enzyme response significantly higher than that produced by 50 ng/kg/h, demonstrating that the doses of cerulein generally used in clinical practice to explore the exocrine pancreatic function are not supramaximal.

Topics: Adult; Bicarbonates; Ceruletide; Chronic Disease; Chymotrypsin; Clinical Trials as Topic; Exocrine Pancreatic Insufficiency; Humans; Infusions, Intravenous; Lipase; Male; Middle Aged; Pancreatic Function Tests; Pancreatitis; Random Allocation

Topics: Acetylcysteine; Adult; Aged; Airway Obstruction; Asthma; Bicarbonates; Bronchiectasis; Bronchitis; Chronic Disease; Chymotrypsin; Clinical Trials as Topic; Deoxyribonucleases; Expectorants; Humans; Middle Aged; Peptide Hydrolases; Pneumonia; Pulmonary Emphysema; Sodium; Streptodornase and Streptokinase; Surface-Active Agents; Trypsin

Type 3C Diabetes, or diseases of the exocrine pancreas has been reported to occur in approximately 30% of adult patient with pancreatitis. The incidence of glucose abnormalities or risk factors that may predict the development of abnormal glucose in the pediatric pancreatitis population is not known. We performed a retrospective chart review from 1998-2016 for patients who carry the diagnosis of acute pancreatitis (AP), acute recurrent pancreatitis (ARP), and chronic pancreatitis (CP). We extracted glucose values, HbA1c%, and data from oral glucose tolerance and mixed meal testing with timing in relation to pancreatic exacerbations. Patient characteristic data such as age, gender, body proportions, family history of pancreatitis, exocrine function and genetic mutations were also assessed. Abnormal glucose was based on definitions put forth by the American Diabetes Society for pre-diabetes and diabetes. Fifty-two patients had AP and met criteria. Of those, 15 (29%) had glucose testing on or after the first attack, 21 (40%) were tested on or after the second attack (in ARP patients) and 16 (31%) were tested after a diagnosis of CP. Of the patients tested for glucose abnormalities, 25% (13/52) had abnormal glucose testing (testing indicating pre-DM or DM as defined by ADA guidelines. A significantly higher proportion of the abnormal glucose testing was seen in patients (85%, 11/13) with a BMI at or greater than the 85th percentile compared to the normal glucose patients (28%, 11/39) (p = 0.0007). A significantly higher proportion of the abnormal glucose patients (77%, 10/13) had SAP during the prior AP episode to testing compared to the 10% (4/39) of the normal glucose patients (p<0.0001). Older age at DM testing was associated with a higher prevalence of abnormal glucose testing (p = 0.04). In our patient population, a higher proportion of glucose abnormalities were after the second episode of pancreatitis, however 62% (8/13) with abnormalities was their first time tested. We identified obesity and having severe acute pancreatitis (SAP) during the prior AP episode to testing could be associated with abnormal glucose. We propose that systematic screening for abnormal glucose after the first episode of acute pancreatitis in order to better establish the timing of diabetes progression.

Topics: Acute Disease; Blood Glucose; Child; Chronic Disease; Chymotrypsin; Female; Genetic Predisposition to Disease; Glucose; Glucose Tolerance Test; Glycated Hemoglobin; Humans; Male; Pancreatitis; Polymorphism, Genetic; Prevalence; Recurrence; Retrospective Studies; Risk Factors; Trypsin; Trypsin Inhibitor, Kazal Pancreatic

Single-centered studies show increased number of acute pancreatitis (AP) in children. Here, the Pediatric Section of the Hungarian Pancreatic Study Group introduces an international observational clinical trial (APPLE) to collect a critical mass of clinical data and biomedical research samples in a uniform prospective manner.. The APPLE-R is for patients under 18 years of age with a history of pancreatitis. The study primarily provides information on possible genetic variants behind the disease and their impact on the prognosis. The APPLE-P is for patients under 18 years of age with a diagnosis of AP. Children with AP diagnosed based on the fulfillment of '2 out of 3' of the Atlanta criteria will be selected. This subtrial requests detailed information from the medical history, etiology, complains and symptoms, physical examinations, laboratory parameters, imaging, immediate therapy at admission and complications of the disease. The APPLE trial has been registered at the ISRCTN registry and has received the relevant ethical approval. The study is open for all pediatric centers throughout the world.. This is the first worldwide study tracking earlier (APPLE-R) and ongoing episodes (APPLE-P) of pancreatitis.

Topics: Acute Disease; Adolescent; Carboxypeptidases A; Carrier Proteins; Child; Child, Preschool; Chronic Disease; Chymotrypsin; Cystic Fibrosis Transmembrane Conductance Regulator; Discriminant Analysis; Female; Hospitalization; Humans; Hungary; Infant; Infant, Newborn; Lipase; Logistic Models; Male; Pancreatitis; Prognosis; Prospective Studies; Registries; Trypsin; Trypsin Inhibitor, Kazal Pancreatic

This study aimed to investigate the association between chronic pancreatitis and smoking or genetic mutations.. The study sample comprised 148 patients with chronic pancreatitis, 110 chronic alcoholic subjects without pancreatic disease, and 297 volunteer blood donors.. Of the patients with chronic pancreatitis, 74% had alcoholic etiology and 26% had idiopathic pancreatitis. The frequency of smoking was 91.4% in patients with alcoholic pancreatitis, higher than 73.3% in alcoholic subjects without pancreatitis (P < 0.01). The difference in smoking frequency was not significant between the patients with idiopathic pancreatitis and blood donors. The N34S mutation of serine peptidase inhibitor, Kazal type 1 (SPINK1) was found in 2.7% of patients with chronic alcoholic pancreatitis, in 5.3% of patients with idiopathic pancreatitis, and in 0.4% of blood donors (P = 0.02). The P55S mutation of SPINK1 was found in 2.7% of patients with alcoholic pancreatitis and in 0.7% of blood donors (P = 0.12). The R254W mutation of chymotrypsin C was found in 0.9% of patients with alcoholic pancreatitis, in 0.9% of chronic alcoholic subjects without pancreatitis, and in 0.4% of blood donors (P = 0.75). In all cases, the mutations were heterozygous.. Smoking and the N34S mutation of SPINK1 were positively correlated with chronic pancreatitis.

Topics: Chronic Disease; Chymotrypsin; Genetic Predisposition to Disease; Humans; Mutation; Pancreatitis; Serine; Trypsin Inhibitor, Kazal Pancreatic

We recently reported that the proteasomal peptidase activities are altered in the cerebellum of mice with myelin oligodendrocyte glycoprotein (MOG) peptide-induced experimental autoimmune encephalomyelitis (EAE). To determine whether these fluctuations are caused by proteasome activation/inactivation and/or changes in the levels of individual β subunits, we characterized the proteasome subunit composition by western blotting. The results show that the rise in proteasomal peptidase activity in acute EAE correlates with an augmented expression of inducible β subunits whereas the decline in activity in chronic EAE correlates with a reduction in the amount of standard β subunits. Using pure standard (s) and immuno (i) 20S particles for calibration, we determined that the changes in the levels of catalytic subunits account for all of the fluctuations in peptidase activities in EAE. The i-20S and s-20S proteasome were found to degrade carbonylated β-actin with similar efficiency, suggesting that the amount of protein carbonyls in EAE may be controlled by the activity of both core particles. We also found an increase in proteasome activator 11S regulatory particle and a decrease in inhibitor proteasome inhibitor with molecular mass of 31 kDa levels in acute EAE, reflecting a response to inflammation. Elevated levels of 19S regulatory particle and 11S regulatory particle in chronic EAE, however, may occur in response to diminished proteasomal activity in this phase. These findings are central towards understanding the altered proteasomal physiology in inflammatory demyelinating disorders.

Topics: Acute Disease; Aging; Animals; Blotting, Western; Caspases; Catalysis; Cerebellum; Chronic Disease; Chymotrypsin; Encephalomyelitis, Autoimmune, Experimental; Female; Mice; Mice, Inbred C57BL; Oxidation-Reduction; Proteasome Endopeptidase Complex; Protein Carbonylation; Trypsin

Chronic pancreatitis (CP) is characterized by intractable abdominal pain, and pancreatic exocrine and endocrine dysfunction. This study investigated whether early surgical drainage of pancreatic duct obstruction leads to improved recovery of pancreatic function compared with late surgical drainage in an experimental model of chronic obstructive pancreatitis.. Twenty-one piglets underwent pancreatic duct ligation and subsequent longitudinal pancreaticojejunostomy after 3 weeks (early drainage) or 6 weeks (late drainage), and drainage continued for 6 weeks. In controls with CP pancreatic duct ligation was continued for 12 weeks without a drainage procedure.. Histological pancreatitis scores decreased with early drainage (P = 0.005), but not with late drainage. Pancreatic secretion of amylase and lipase was restored after early but not late drainage (P = 0.003 and P = 0.048 respectively). Excretion levels of lipase were restored to near-baseline preligation levels after early drainage. Pancreatic endocrine function (glucose tolerance test) showed no insufficiency in either group.. In this model of early versus late surgical drainage of obstructive pancreatitis, histology grades and pancreatic exocrine function showed improvement in the early drainage group but no recovery in the late drainage group.

Topics: Amylases; Animals; Blood Glucose; Chronic Disease; Chymotrypsin; Constriction, Pathologic; Drainage; Feces; Female; Ligation; Lipase; Models, Animal; Pancreaticojejunostomy; Pancreatitis, Chronic; Pressure; Swine; Time Factors

The contribution of human gastric lipase (HGL) to the overall lipolysis process in chronic pancreatitis (CP), as well as the relative pancreatic enzyme levels, rarely are addressed. This study was designed to quantify pancreatic and extrapancreatic enzyme output, activity, and stability in CP patients vs. healthy volunteers.. Healthy volunteers (n = 6), mild CP patients (n = 5), and severe (n = 7) CP patients were intubated with gastric and duodenal tubes before the administration of a test meal. HGL, human pancreatic lipase (HPL), chymotrypsin, and amylase concentrations were assessed in gastric and duodenal samples by measuring the respective enzymatic activities. Intragastric and overall lipolysis levels at the angle of Treitz were estimated based on quantitative analysis of lipolysis products. Similar analyses were performed on duodenal contents incubated ex vivo for studying enzyme stability and evolution of lipolysis.. Although HPL, chymotrypsin, and amylase outputs all were extremely low, HGL outputs in patients with severe CP (46.8 +/- 31.0 mg) were 3-4-fold higher than in healthy controls (13.3 +/- 13.8 mg). Intragastric lipolysis did not increase, however, in patients with severe CP, probably because of the rapid decrease in the pH level of the gastric contents caused by a higher gastric acid secretion. HGL remains active and highly stable in the acidic duodenal contents of CP patients, and, overall, can achieve a significant lipolysis of the dietary triglycerides (30% of the control values) in the absence of HPL.. Although all pancreatic enzyme secretions are simultaneously reduced in severe CP, gastric lipase can compensate partly for the loss of pancreatic lipase but not normalize overall lipolytic activity.

Topics: Adult; Amylases; Case-Control Studies; Chronic Disease; Chymotrypsin; Digestion; Gastric Emptying; Gastrointestinal Tract; Humans; Lipase; Lipolysis; Middle Aged; Pancreatitis; Severity of Illness Index

Alpha-1-antitrypsin (alpha1-AT) is a member of the serine protease inhibitor family regulating numerous proteolytic processes. The genetic disorder, alpha1-AT deficiency, is well known as a cause of hereditary pulmonary emphysema and liver cirrhosis. To create an animal model of human alpha1-AT deficiency, we disrupted the major murine isoform PI2, which is similar to human alpha1-AT and is one of 7 alpha1-AT isoforms found in the mouse. The ability of the serum to inhibit the activities of human leukocyte elastase (HLE) and human chymotrypsin (CYT) was significantly lower in heterozygous mice (alpha1-AT/PI2 -/+) than wild-type (alpha1-AT/PI2 +/+) mice (73.2% vs. 100% for HLE and 67.8% vs.100% for CYT, respectively; P<0.05). The distribution of genotypes among F(2) progeny was not in accordance with Mendelian distribution (P<0.01), as the percentages of wild-type, heterozygotes and homozygotes were 47.8%, 37.3% and 14.9%, respectively. Thus, it is likely that impairment of the protease inhibitor had a critical effect on fetus development. The alpha1-AT/PI2 deficient mouse will be a useful animal model for elucidating the function of alpha1-AT in fetal development, studying the mechanisms of chronic inflammatory disease and evaluating therapeutic candidates for the treatment of inflammatory disease.

Topics: alpha 1-Antitrypsin; alpha 1-Antitrypsin Deficiency; Animals; Chronic Disease; Chymotrypsin; Disease Models, Animal; Female; Fetal Development; Inflammation; Leukocyte Elastase; Male; Mice; Mice, Inbred BALB C; Mice, Inbred C57BL; Proteins; Serpins

On the basis of their amino acid sequences, tryptases are just another group of serine proteinases related to trypsin that happen to be expressed and stored in mast cells rather than the pancreas. On the basis of their biochemical and biological features, however, tryptases show little family likeness to trypsin and most other trypsin-like proteases. The intriguing discrepancies have been explained by the crystal structure of the tryptase tetramer. It is now clear how tryptases, by forming tetramers, have gained the ability to prevail enzymatically active in tissues, but, at the cost of an unusual narrow substrate specificity. The tryptase tetramer thus became both a (neuro)peptidase and a long-lasting initiator that orchestrates responses by the cleavage of a few key proteins, the activation of other proteases with broader specificity, and the stimulation of cellular responses. With the support of these performers, tryptase drives a variety of processes contributing to chronic inflammation and tissue remodeling, the diversity of which is still emerging.

Topics: Animals; Aprotinin; Asthma; Bronchi; Bronchoconstriction; Cell Degranulation; Chronic Disease; Chymotrypsin; Dogs; Humans; Inflammation; Inflammation Mediators; Mast Cells; Mice; Muscle, Smooth; Pancreatic Elastase; Peptide Hydrolases; Protease Inhibitors; Proteinase Inhibitory Proteins, Secretory; Proteins; Serine Endopeptidases; Serine Proteinase Inhibitors; Sheep; Species Specificity; Substrate Specificity; Tryptases

We report our initial clinical experience with local transrectal application of enzymatic treatment for chronic nonbacterial prostatitis and prostatodynia in 20 patients. Using a specially designed symptom score for evaluation of subjective treatment parameters, a statistically significant improvement of symptoms was found in the areas of pain, micturition, and recreational activities. No statistically significant differences were noted in laboratory values before and after treatment. Minimal local side effects were seen in only one patient. A favorable clinical response was noted in 75% of patients, whereas the remaining 25% showed only moderate improvement of symptoms. No patient experienced complete treatment failure.

Topics: Adjuvants, Immunologic; Administration, Rectal; Adult; Aged; Aged, 80 and over; Chronic Disease; Chymotrypsin; Drug Combinations; Humans; Male; Middle Aged; Pain; Pain Measurement; Pancreatic Extracts; Papain; Prostatic Diseases; Prostatitis; Retrospective Studies; Thymus Extracts; Treatment Outcome; Trypsin

We have studied the effects of various angiotensin-converting enzyme (ACE) inhibitors on intraocular pressure (IOP) of rabbits with experimentally induced ocular hypertension and their mechanism of action. Acute ocular hypertension was induced by infusion of 5% glucose (15 ml/kg) through marginal ear vein, whereas chronic glaucoma was induced by injection of alpha-chymotrypsin into the posterior chamber of the eye. IOP was measured by tonometer. All ACE inhibitors were instilled topically in the eye in a sterile solution. The effect of ACE inhibitors also was studied on serum cholinesterase (true and pseudo) and the enzyme ACE in vitro. Enalaprilat, ramiprilat, and fosinopril produced a time-dependent decrease of IOP in both acute and chronic models of ocular hypertension in rabbits. The decrease in IOP was observed for >4 h, and the extent of decrease was comparable to that with both pilocarpine and betaxolol. Prodrugs enalapril and ramipril failed to produced any change in IOP. Losartan also produced a significant decrease in IOP in the chronic model of ocular hypertension in rabbits. All the three ACE inhibitors were found to inhibit ACE activity in aqueous humor. The enzyme cholinesterase was found to be inhibited by enalaprilat, ramiprilat, and fosinopril. However, atropine did not alter the IOP-lowering effect of enalaprilat in rabbits. Indomethacin pretreatment produced slight but significant inhibition of the IOP-lowering effect of enalaprilat in rabbits. Our data suggest that ACE inhibitors enalaprilat, ramiprilat, and fosinopril produce a significant ocular hypotensive effect in acute and chronic models of ocular hypertension in rabbits. Inhibition of ACE in aqueous humor, and in ocular tissues, resulting in reduced angiotensin II formation, could be one of the major mechanisms responsible for the IOP reduction by ACE inhibitors in rabbits.

Topics: Acute Disease; Angiotensin-Converting Enzyme Inhibitors; Animals; Aqueous Humor; Cholinesterases; Chronic Disease; Chymotrypsin; Glaucoma; Intraocular Pressure; Ocular Hypertension; Peptidyl-Dipeptidase A; Rabbits

This study assessed the diagnostic accuracy of fecal elastase 1 in chronic pancreatitis. Fifty-three healthy subjects, 44 patients with chronic pancreatitis (22 severe, 13 moderate, and 9 mild), and 43 patients with nonpancreatic digestive disease were studied. Elastase 1 concentration was determined on a small sample of feces using a commercially available kit. Fecal chymotrypsin was also measured. With a cutoff level of 190 microg/g, all healthy controls except one (98.1%), and the majority of patients with nonpancreatic digestive diseases (40 of 43; 93.0%) had elastase values above this limit. Among the 44 patients with chronic pancreatitis, 34 (77.3%) had pathological values: all 22 (100%) with severe disease, 10 of 13 (76.9%) with moderate disease and 2 of 9 (22.2%) with mild disease. Chymotrypsin values were pathological in 25 of 44 (56.8%) patients with chronic pancreatitis: 17 of 22 (77.2%) with severe pancreatitis, 7 of 13 (53.8%) with moderate pancreatitis, and 1 of 9 (11.1%) with mild disease. The specificity was 95.8% for elastase 1 and 85.4% for chymotrypsin. The difference both in sensitivity and specificity of the two enzymes was statistically significant (P < 0.05). Fecal elastase 1 has a high sensitivity, superior to that of fecal chymotrypsin, in the diagnosis of chronic pancreatitis. For its simplicity and rapidity, it could represent the tubeless test of choice in chronic pancreatitis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biomarkers; Chronic Disease; Chymotrypsin; Feces; Female; Humans; Male; Middle Aged; Pancreatic Elastase; Pancreatitis; Sensitivity and Specificity

The clinical diagnosis of chronic pancreatitis is usually based on imaging studies, pancreatic function tests, and the presence of characteristic clinical features. In Japan, diagnostic criteria for chronic pancreatitis were established in 1995. The secretin test (a duodenal intubation test) and the combination of noninvasive tests, N-benzoyl-L-tyrosyl-p-aminobenzoic acid (BT-PABA) and fecal chymotrypsin (FCT), have been recommended for evaluating exocrine pancreatic function in patients with chronic pancreatitis. In the present study, the diagnostic value of these two noninvasive tests was compared to the secretin test. Although noninvasive tests are less sensitive and specific for determining exocrine pancreatic dysfunction than the secretin test, greater reliability for diagnosing chronic pancreatitis can be obtained by performing the BT-PABA and FCT simultaneously. Assessment of exocrine pancreatic function is important not only to diagnose chronic pancreatitis but also to decide a treatment method with pancreatic enzyme preparation.

Topics: 4-Aminobenzoic Acid; Chronic Disease; Chymotrypsin; Diagnosis, Differential; Feces; Humans; Pancreas; Pancreatitis; para-Aminobenzoates; Secretin

Topics: Animals; Chronic Disease; Chymotrypsin; Endopeptidase K; Influenza A virus; Lung; Mice; Orthomyxoviridae Infections; Pneumonia

We describe the clinical history, histopathology and treatment of a two and a half year old boy. He presents with a chronic, unilateral and (pseudo) membranous conjunctivitis, preceded by ear-nose-throat problems and arthritis. The case was considered to be a ligneous conjunctivitis. Treatment consisted of repeated removal of the membranes, combined with topical hyaluronidase, alpha-chymotrypsin, cyclosporin, heparin and antibiotics, and was deceiving.

Topics: Anti-Bacterial Agents; Child, Preschool; Chronic Disease; Chymotrypsin; Conjunctivitis; Cyclosporine; Diagnosis, Differential; Heparin; Humans; Hyaluronoglucosaminidase; Male

Group of 100 patients with proven CP was analysed through the period of 5-20 years. According to duration of pancreatic disease patients were divided in three groups: 2-5 years from the onset of disease (12 patients), 5-8 years from the onset of disease (35 pts) and more than 8 years from the onset of disease (35 pts). At the start of the study all patients have refereed abdominal pain. Chymotripsin activity, BMI, patients' age, occurrence of diabetes and frequency of pain cessation between groups was compared. Significantly higher frequency of diabetics was found in group with longer duration of CP, as expected. Occurrence of pain declined significantly more often in those CP patients with associated diabetes as compared to those without diabetes. Cessation of pain was most prominent in patients with diabetes lasting for more than 8 years. Decline of pain frequency in CP patients despite the progressive pancreatic damage seems to be caused primarily by microvascular changes similar or identical to those occurring in diabetes.

Topics: Abdominal Pain; Adult; Aged; Aged, 80 and over; Chronic Disease; Chymotrypsin; Diabetes Complications; Female; Humans; Longitudinal Studies; Male; Middle Aged; Pancreatitis

The determination of faecal pancreatic elastase 1 is a reliable test for the diagnosis of chronic pancreatic diseases in man due to its high sensitivity and specificity (93%). A clinical study was performed to investigate the detectability of canine faecal pancreatic elastase with polyclonal anti human pancreatic elastase 1 antibodies in 52 dogs with chronic diarrhoea and weight loss. To assess the diagnostic value of this parameter for the diagnosis of exocrine pancreatic insufficiency (EPI) in dogs faecal chymotrypsin activity was determined and serum trypsin-like immunoreactivity (TLI) concentration was measured within the Ceruletid test in all patients. The study revealed that canine faecal pancreatic elastase cross reacts with polyclonal anti human pancreatic elastase 1 antibodies. In comparison with the results of the other pancreas tests it was proved that the concentration of canine faecal pancreatic elastase determined by rocket immunoelectrophoresis is highly sensitive for EPI in dogs (sensitivity 100%) but there are species differences in specificity between man and dog (specificity 56.5%).

Topics: Animals; Antibodies; Chronic Disease; Chymotrypsin; Diarrhea; Dog Diseases; Dogs; Feces; Humans; Immunoelectrophoresis; Pancreatic Diseases; Pancreatic Elastase; Predictive Value of Tests; Sensitivity and Specificity; Trypsin; Weight Loss

Fecal elastase-1 is a candidate for a sensitive noninvasive test detecting chronic pancreatitis. This prospective study enrolled 10 healthy male controls and 23 patients referred for tube testing of pancreatic function. It was designed (a) to correlate duodenal outputs and fecal concentrations of elastase-1 with duodenal outputs of amylase, lipase, trypsin, and chymotrypsin in the fed state (duodenal perfusion of a mixed liquid meal at 2.5 kcal/min for 150 min), (b) to compare the diagnostic accuracy of fecal elastase-1 and fecal chymotrypsin, and (c) to characterize the cyclical pattern of postprandial pancreatic secretion in healthy subjects and patients with chronic pancreatitis. Based on their enzyme responses to duodenal meal perfusion and imaging procedures, 12 patients were classified as having normal pancreatic function and 11 patients as having chronic pancreatitis. Duodenal enzyme outputs of elastase-1 were markedly lowered in chronic pancreatitis (p < 0.0001) and correlated well with the outputs of the other four enzymes (r > 0.71, p < 0.00001). Fecal concentrations of elastase-1 were also clearly reduced in chronic pancreatitis (p < 0.0001). Fecal chymotrypsin was less strongly associated with duodenal enzyme outputs (r = 0.33 to r = 0.587), whereas fecal elastase-1 correlated more precisely with the duodenal outputs of all five enzymes (r = 0.637 to r = 0.830, p < 0.00001). Sensitivity and specificity in the detection of chronic pancreatitis amounted to 0.64 and 0.95 for fecal elastase-1 and 0.27 and 0.95 for fecal chymotrypsin, respectively. In the postprandial state, peaks of enzyme secretion occurred at a frequency of about 1 peak/150 min. The amplitude but not the frequency of secretory peaks was markedly reduced in chronic pancreatitis (p < 0.01). We conclude that fecal elastase-1 clearly exceeds the sensitivity of fecal chymotrypsin in the diagnosis of chronic pancreatitis but does not reliably detect all cases with mild to moderate disease. The pattern of postprandial pancreatic secretion is cyclical, even with minimal secretory outputs in chronic pancreatitis.

Topics: Adult; Aged; Chronic Disease; Chymotrypsin; Duodenum; Feces; Female; Food; Humans; Lipase; Male; Middle Aged; Pancreas; Pancreatic Elastase; Pancreatitis; Trypsin

Indirect pancreatic function tests available today are unreliable for clinical practice in early chronic pancreatitis due to their low sensitivity in mild and moderate exocrine pancreatic insufficiency.. To evaluate the sensitivity, specificity, and practicability of faecal elastase 1 determination in patients with mild, moderate, and severe exocrine pancreatic insufficiency categorised according to the secretin-caerulein test as "gold standard'.. Faecal and duodenal elastase 1 concentration (commercial enzyme linked immunosorbent assay (ELISA)), faecal chymotrypsin activity, faecal fat analysis, and the secretin-caerulein test were performed on 44 patients with mild (n = 8), moderate (n = 14), and severe (n = 22) exocrine pancreatic insufficiency and 35 patients with gastrointestinal diseases of non-pancreatic origin. Fifty healthy volunteers were studied as normal controls. Morphological examinations were carried out to definitely confirm or exclude chronic pancreatitis.. With a cut off of 200 micrograms elastase 1/g stool the sensitivity was 63% for mild, 100% for moderate, 100% for severe, and 93% for all patients with exocrine pancreatic insufficiency, and specificity was 93%. Values for chymotrypsin were 64% (sensitivity) and 89% (specificity). Significant (p < 0.001) correlations were found for faecal and duodenal elastase with duodenal lipase, amylase, trypsin, volume, and bicarbonate output. Individual day to day variations of faecal elastase 1 concentrations were very low (mean CV = 15%) and sample storage at room temperature is possible for at least one week.. Faecal elastase 1 determination proved to be a highly sensitive and specific tubeless pancreatic function test.

Topics: Adult; Chronic Disease; Chymotrypsin; Duodenum; Evaluation Studies as Topic; Exocrine Pancreatic Insufficiency; Feces; Female; Humans; Lipids; Male; Pancreatic Elastase; Regression Analysis; Sensitivity and Specificity

Secretions from the exocrine and endocrine pancreas may modulate interdigestive motility. To test this hypothesis in humans, we investigated interdigestive cycling in patients with chronic pancreatitis (CP) as a model of impaired pancreatic function.. Antroduodenal motility, pancreatic enzyme output, and pancreatic polypeptide release were monitored for two consecutive interdigestive cycles in 13 controls and 9 patients with CP.. Interdigestive enzyme output was severely impaired in patients with CP (> 80% decrease); however, secretory cycling was still evident in most patients. All parameters describing interdigestive motility were similar in controls and patients with CP (duration of the migrating motor complex [MMC] was 107 +/- 19 minutes in patients with CP vs. 114 +/- 15 minutes in controls). The time between cyclic peaks of enzyme secretion (76 +/- 4 minutes vs. 101 +/- 4 minutes in controls) and pancreatic polypeptide (63 +/- 4 minutes vs. 106 +/- 7 minutes in controls) was shortened in patients with CP, and peaks were no longer temporally related to the MMC. Only 56% of phase III activity fronts were associated with a concomitant secretory peak in patients with CP compared with 92% in healthy subjects.. CP not only decreases pancreatic secretion but interrupts the coordination among interdigestive cyclic phenomena. Our findings in several animal and human models refute the concept that pancreatic mechanisms exert a major regulatory influence on interdigestive motor activity.

Topics: Adult; Amylases; Analysis of Variance; Chronic Disease; Chymotrypsin; Digestion; Duodenum; Female; Gastrointestinal Motility; Humans; Male; Middle Aged; Myoelectric Complex, Migrating; Pancreas; Pancreatic Polypeptide; Pancreatitis; Periodicity; Pyloric Antrum; Trypsin

Pancreatic elastase is highly stable along the intestinal tract. A new ELISA is commercially available to measure human specific elastase-1 concentration in stool. We evaluated the behavior of this fecal elastase test (FET) compared with other indirect pancreatic function tests in patients with chronic pancreatitis (CP).. A total of 69 patients were included in the study, 20 of whom were diagnosed with CP according to the findings on ERP and CT; 13 patients had other pancreatic diseases, and the remaining 36 patients had gastrointestinal or hepatic disorders. All patients' elastase-1 concentrations and chymotrypsin activities [fecal chymotrypsin test (FCT)] were measured, and the serum pancreolauryl test (PLT) was performed.. Similar to PLT, fecal elastase concentration was significantly decreased in patients with moderate and severe CP (assessed by ERP) compared with patients with extrapancreatic disorders. However, and contrarily to PLT, FET was not affected by gastric resection, malabsorption due to intestinal disease, or marked alteration of the gastric motility. The sensitivity of FET was 100% for moderate to severe CP but 0% for mild CP; the specificity was 83%. Compared with other indirect pancreatic function tests, FET appears to be as sensitive as PLT and as specific as FCT, and it is clearly more specific than PLT and more sensitive than FCT. Unlike FCT, FET was not affected by oral enzyme supplementation.. FET is a simple and accurate functional test for CP, and it is hardly influenced by extrapancreatic disorders or therapy with exogenous enzymes.

Topics: Adolescent; Adult; Aged; Cholangiopancreatography, Endoscopic Retrograde; Chronic Disease; Chymotrypsin; Clinical Enzyme Tests; Feces; Female; Fluoresceins; Humans; Male; Middle Aged; Pancreatic Elastase; Pancreatic Function Tests; Pancreatitis; Tomography, X-Ray Computed

The exocrine and endocrine pathophysiology of chronic calcific pancreatitis of the tropics (CCPT) remains elusive. The objective of this study was to evaluate the spectrum and correlates of the exocrine and endocrine pancreatic dysfunction in CCPT. Thirty-seven consecutive patients with a clinico-radiological diagnosis of CCPT were stratified into three subgroups: CCPT-normal glucose tolerance (NGT), CCPT-abnormal glucose tolerance (IGT) and CCPT-diabetes mellitus (DM). Ten ketosis resistant young diabetic (KRDY) patients, 10 classical insulin dependent diabetes mellitus (IDDM) patients and 18 healthy matched controls were included for comparison. Fecal chymotrypsin (FCT) levels and blood C-peptide levels (basal and post i.v. glucagon stimulation) were estimated for assessing the exocrine and endocrine pancreatic functions, respectively. Sonography was performed to evaluate the pancreatic size and ductal diameter. Pancreatic exocrine-endocrine correlation was examined by studying the C-peptide/fecal chymotrypsin ratio (CP/FCT) (CP/FCT of normal controls = 1). Mean FCT levels in all 3 subgroups of CCPT (NGT: 3.4 micrograms/g; IGT: 0.82 microgram/g; DM: 2.4 micrograms/g) were very low (87-96% reduction in exocrine pancreatic dysfunction; mean FCT in healthy controls was 22.8 micrograms/g) (P < 0.0001). In contrast, KRDY and IDDM patients displayed 50-54% reduction in pancreatic acinar function (P < 0.001). Basal and stimulated C-peptide levels progressively fell in the 3 CCPT subsets (NGT: 0.23 and 0.46 > IGT: 0.14 and 0.29 > DM 0.10 and 0.14) (P < 0.01). CCPT patients exhibited pancreatic atrophy and ductal dilation (> 3 mm).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Age of Onset; Analysis of Variance; Blood Glucose; C-Peptide; Calcinosis; Chronic Disease; Chymotrypsin; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Female; Glucagon; Glucose Intolerance; Glucose Tolerance Test; Humans; Islets of Langerhans; Male; Pancreas; Pancreatitis; Reference Values; Tropical Climate; Ultrasonography

The steady increase in chronic pancreatitis among black Africans at Soweto, RSA, in the past 40 years necessitates an objective and non-invasive test to detect the disease at an early stage. Given the biphasic nature of the disease--secretory hyperfunction with periodic active inflammatory episodes followed by steady exocrine impairment--we assessed three potential aids. Urinary BT-PABA/PAS excretion index (PEI), serum pancreatic isoamylase (PIA) and faecal chymotrypsin activity (FCA) were measured in the following groups: 16 outwardly healthy hospital workers, 16 consecutive patients with calcifying chronic pancreatitis and 19 with abdominal pain ascribed to other conditions (disease controls). (1) Healthy controls had lower PEI than those at Manchester, UK, or Madras, India, from subclinical acinar loss--as shown by lower PABA recovery whereas intestinal absorptive capacity was maintained, as shown by recovery of PAS. (2) Using the popular cut-off for PEI (0.75) only 9 of 14 patients with chronic pancreatitis were identified (sensitivity 64%, 2 tests unsatisfactory), while a value of less than 0.54, the mean -2 S.D. in local controls, yielded sensitivity of 50%. (3) If PEI of less than 0.75 or PIA outside the reference range was taken to indicate the disease, 5 of 9 disease controls would have been classed as chronic pancreatitis (among those with both tests satisfactory): retrospective ultrasound scans did not identify these. (4) Although FCA was less than the preselected cut-off, 5 units/g, in every patient with chronic pancreatitis (100% sensitivity) its poor predictive value was indicated by low specificity: subnormal levels in 4 of 14 and 6 of 16 healthy controls or disease controls, respectively, most of whom had near-normal values of PEI, PIA or both. (5) Collectively, these results suggest a high frequency of subclinical chronic pancreatitis at Soweto, but also that the combination of tests required to identify it may prove impractical--whether in field surveys or hospital practice.

Topics: 4-Aminobenzoic Acid; Adult; Aminosalicylic Acid; Biomarkers; Black People; Chronic Disease; Chymotrypsin; Feces; Female; Humans; Isoamylase; Liver Function Tests; Male; Middle Aged; Pancreatitis; para-Aminobenzoates; Reference Values; South Africa; Urban Population

The aim of the presented study was a comparative evaluation of the three indirect pancreatic function tests: pancreolauryl-test (PLT), NBT-PABA test and faecal chymotrypsin (CH) efficacy in detecting pancreatic exocrine function impairment in advanced chronic pancreatitis (acp). 30 patients with severe chronic pancreatitis (marked structure changes in ultrasound and CT following Cambridge criteria) confirmed by abnormal secretin-cerulein test (SCT) and 10 healthy controls underwent PLT, NBT-PABA and CH tests. The degree of pancreatic function impairment in SCT was classified following Malfertheiner into 3 subgroups: 1-mild, 2-moderate and 3-severe. All the indirect pancreatic function test were performed using commercially available kits (Temmler-Werke for PLT, Hoffman-La Roche for NBT-PABA and Boehringer Mannheim for CH) according to manufacturer instructions. PLT revealed changes in 27 (0.9), NBT-PABA-in 25 (0.83) and CH-in 22 (0.73) patients with acp. On the other hand those test have shown normal pancreatic function: PLT-in 0.9, NBT-PABA-in 0.7 and CH-in 0.8 in control group. The sensitivity of those test was increased up to 0.94 (PLT and NBT-PABA) and up to 0.88 (CH) and in the subgroup of severely impaired pancreatic function test in SCT. The concomittant use of two indirect pancreatic function tests caused increase of sensitivity up to 0.93. Our results suggest that with PLT, NBT-PABA and CH impaired pancreatic function may be succesfully recognized in advanced chronic pancreatitis, in particular, when two of them are applied concomittantly.

Topics: 4-Aminobenzoic Acid; Adult; Aged; Chronic Disease; Chymotrypsin; Feces; Female; Fluoresceins; Humans; Indicators and Reagents; Male; Middle Aged; Pancreatic Function Tests; Pancreatitis; para-Aminobenzoates; Sensitivity and Specificity; Tomography, X-Ray Computed

It has recently been shown that the infusion of oleic acid into the rat pancreaticobiliary duct causes a reproducible and long-lasting atrophy of the exocrine pancreas. The effects of this pancreatic atrophy on non-invasive pancreatic function tests have not been fully characterized. This study was undertaken to determine which pancreatic function test was most useful in determining pancreatic insufficiency in this model. Pancreatic insufficiency (PI) was induced in male Wistar rats by oleic acid infusion and three pancreatic function tests were compared in these animals and saline controls. The coefficient of fat absorption on a 5 or 45% fat diet and bentiromide testing could not differentiate animals with or without PI, but fecal chymotrypsin levels were excellent discriminators. All animals with PI had fecal chymotrypsin levels below 67 U/g feces whereas all saline controls were above this level. We conclude that, in this model of PI, the fecal chymotrypsin concentration is the best non-invasive test to determine pancreatic insufficiency.

Topics: Absorption; Animals; Chronic Disease; Chymotrypsin; Chymotrypsinogen; Dietary Fats; Disease Models, Animal; DNA; Exocrine Pancreatic Insufficiency; Feces; Lipase; Male; Oleic Acid; Oleic Acids; Pancreas; Pancreatic Function Tests; Rats; Rats, Wistar

187 patients were checked up over 4 years by the secretin-ceruletide test. Independently of the test results they were assigned to various disease groups on the basis of clinical assessment. 131 subjects were divided in a pilot investigation into: subjects with a healthy pancreas (n = 55); subjects with chronic pancreatitis (n = 50); subjects whose pancreatic condition could not be classified clearly (n = 26). 8 parameters were compared by univariate and multivariate statistical procedures in order to confirm or rule out the presence of chronic pancreatitis. The discriminatory power of the following parameters in duodenal fluid proved to be sufficiently high, with less than 15% frequency of misclassification: chymotrypsin (activity) and/or; lipase (activity) and/or; amylase (activity); viscosity. Under routine conditions measurement of the activity of two of these enzymes is sufficient. Their contribution to discrimination proved to be approximately equal. The diagnostic sensitivity and specificity of the parameters bicarbonate, lipase (concentration), trypsin (activity) and volume of duodenal fluid are lower. The classification rules derived from the above pilot group were confirmed by a diagnostic study under routine condition in a test group of 38 patients. Limitation to examining only volume and a maximum of 3 parameters which proved best in distinguishing between patients with chronic pancreatitis and healthy subjects, together with the omission of the first-hour samples after a secretin bolus, considerably reduced laboratory workload without altering the discriminatory power of the secretin-ceruletide test.

Topics: Adult; Alcoholism; Amylases; Ceruletide; Chronic Disease; Chymotrypsin; Duodenum; Female; Humans; Intestinal Secretions; Lipase; Male; Middle Aged; Pancreatitis; Reference Values; Secretin; Viscosity

Topics: Aged; Ascorbic Acid; Chronic Disease; Chymotrypsin; Diarrhea; Drug Combinations; Female; Flavonoids; Hesperidin; Humans; Male; Peptide Hydrolases; Phytosterols; Thrombophlebitis; Trypsin

A 'screening' test is needed to identify patients with chronic pancreatitis among diabetics in tropical field surveys. We have examined the potential diagnostic yield of the BT-PABA/PAS test of exocrine pancreatic function in this setting. The recoveries of both PABA and PAS in eight healthy controls from Madras, south India, were lower than in controls from Manchester, north west England (mean +/- S.D., 51 +/- 11 vs. 79 +/- 7%, P < 0.001 for PABA; 52 +/- 11% vs. 81 +/- 7%, P < 0.001 for PAS) but the % PABA/PAS excretion index (PEI) was similar (0.96 +/- 0.14 vs. 0.96 +/- 0.06). Using a cut-off value of 0.75 for the PEI in a study group including eight patients with chronic pancreatitis and 26 with primary forms of diabetes, test sensitivity was 75%, specificity 92%, positive predictive value 75%, negative predictive value 92% and efficiency 88%.

Topics: 4-Aminobenzoic Acid; Aminosalicylic Acid; Chronic Disease; Chymotrypsin; Diabetes Complications; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Feces; Humans; India; Kinetics; Pancreatitis; para-Aminobenzoates; Tropical Climate

Fecal isoamylase activity was studied in 93 consecutive patients (26 in the recovery stage of acute pancreatitis, 24 with chronic pancreatitis, 13 with pancreatic cancer, and 30 with other gastrointestinal diseases) and compared with fecal chymotrypsin activity and the results of the secretin test. Seventy-six healthy subjects were studied as controls. Both pancreatic (p)-type and salivary (s)-type isoamylase activities in stool were determined by inhibitor assay as well as cellulose acetate electrophoresis. The mean fecal amylase activity in healthy subjects was 757 +/- 88 IU/g (p-type isoamylase: 77 +/- 2%, s-type isoamylase: 23 +/- 2%). There was a good correlation between fecal p-type isoamylase and chymotrypsin activities (r = 0.625, p less than 0.001). Fecal p-type isoamylase activity in patients with chronic pancreatitis and pancreatic cancer was significantly lower than in healthy subjects (p less than 0.001). Patients with moderate and severe exocrine pancreatic insufficiency as determined by the secretin test had significantly lower fecal p-type isoamylase activity. Daily fat intake did not affect fecal amylase or isoamylase activities. Fecal s-type isoamylase activity in patients with hypoacidity was significantly higher than in patients with hyperacidity, but no difference in fecal p-type isoamylase activity was observed. It is concluded that analysis of fecal isoamylase activity is useful in the assessment of pancreatic function.

Topics: Acute Disease; Adult; Aged; Amylases; Chronic Disease; Chymotrypsin; Dietary Fats; Enterobacteriaceae; Feces; Female; Gastric Acid; Gastrointestinal Diseases; Humans; Isoamylase; Male; Middle Aged; Pancreatic Neoplasms; Pancreatitis; Secretin

Topics: Chronic Disease; Chymotrypsin; Feces; Humans; Mass Screening; Pancreatitis

Topics: Acute Disease; Animals; Biomarkers, Tumor; Chronic Disease; Chymotrypsin; Clinical Enzyme Tests; Humans; Immunoenzyme Techniques; Isoamylase; Lipase; Pancreatic Elastase; Pancreatic Neoplasms; Pancreatitis; Phospholipases A; Radioimmunoassay; Trypsin

Faecal chymotrypsin was measured in patients with chronic pancreatitis and in healthy black urban and rural control subjects. In the patients, significantly lower values of faecal chymotrypsin were obtained (mean (SD) 2.4 1.79 U/g stool) whereas in urban control subjects, values were within the normal range (mean (SD) 13.2 (11.9)). In rural black control subjects, however, the faecal chymotrypsin value was significantly lower (mean (SD) 7.1 (5.1)) than in urban black control subjects. It is suggested that faecal pH may influence faecal chymotrypsin values. The mean faecal pH in rural black subjects (pH 6.14) was significantly lower than that in urban control subjects (pH 6.77) and in patients with chronic pancreatitis (pH 6.61). Moreover, mean faecal chymotrypsin is high (20.0 U/g stool) at a pH greater than 7. Between pH 6 and 7 the mean value drops to 8.6 U/g stool and below pH 6 mean faecal chymotrypsin is in the abnormal range (4.4 U/g stool). Hence, low values for faecal chymotrypsin may be due to lower faecal pH (less than 6) in healthy control subjects. For diagnostic purposes, the faecal pH value should be determined if a low faecal chymotrypsin value is obtained.

Topics: Adult; Black or African American; Black People; Chronic Disease; Chymotrypsin; Feces; Female; Humans; Hydrogen-Ion Concentration; Male; Pancreatitis; Rural Population; South Africa; Urban Population

Serine proteinases have the potential to influence the degradation of connective tissue in chronic periodontitis, which may progress episodically at individual tooth sites. Elastase-, chymotrypsin- and tryptase-like proteinase activity in homogenized gingival tissue were measured using, respectively, the selective peptide substrates MeOSuc-Ala-Ala-Pro-Val-AFC. MeOSuc-Phe-Pro-Phe-AFC and Z-Ala-Arg-Arg-AFC. Each tooth site was assayed separately and divided, where appropriate, into gingival tissue and granulomata. Elastase-like activity was detected in only about half of the sites and with large variations. Chymotrypsin-like activity decreased with increasing pocket depth, clinical attachment level, gingival index and gingival bleeding index. Tryptase-like activity did not vary consistently with clinical measures. Chymotrypsin- and tryptase-like proteinase activity were much higher in gingival tissue than in granulomata. These effects are best explained by the likely influence (or lack of influence) of the endogenous serum and tissue inhibitors of serine proteinases, the different cellular origins of the enzymes, and their relative affinities for their substrates.

Topics: Adult; Chronic Disease; Chymotrypsin; Female; Gingiva; Gingival Pocket; Gingivitis; Granuloma; Humans; Male; Middle Aged; Pancreatic Elastase; Peptide Hydrolases; Periodontal Index; Periodontitis; Serine Endopeptidases

The study has involved 3702 male patients with gonorrhea. Of these 62 percent were fresh cases, 38 percent chronic ones; there were 218 patients (5.9 percent) with recurrences, of these 63.3 percent with new relapses and 36.7 percent with chronic ones. 85.3 percent of patients developed monorelapses. The recurrences were equally frequent after antibiotic therapy (50.2 percent) and after combined treatment (49.8 percent). Proteolytic enzymes (chymotrypsin, trapsin 5 mg twice daily with a 12 hrs interval) in combination with an antibiotic were administered to 242 patients with gonorrhea complicated by epididymo-orchitis and with gonorrhea relapses. Etiologic cure was achieved in all of them; postgonorrheal conditions were recorded in 6-7 percent and depended on the antibiotic administered; in reference patients recurrences were recorded in 4.2-6.5 percent of cases, postgonorrheal conditions in 14-21.4 percent of cases. Enzymic therapy helped reduce the length of inpatient therapy of a patient by 5.93 days on an average in cases with orchidoepididymitis and by 14.64 days in gonorrhea relapses, with the economic effect per worker being 131.4 and 307.2 rubles, respectively.

Topics: Anti-Bacterial Agents; Chronic Disease; Chymotrypsin; Drug Evaluation; Drug Therapy, Combination; Gonorrhea; Humans; Male; Recurrence; Social Medicine; Trypsin

The existing forms of neutral proteases present in inflamed human gingiva were examined. Neutral 2 M K Cl extracts of inflamed human gingival tissue were fractionated by gel filtration on Sephacryl S-200 and the fractions were assayed for collagenase, trypsin-, chymotrypsin-, and elastase-like proteases. Apparent molecular weights of 80-85 kDa were obtained for trypsin-, chymotrypsin-, and elastase-like proteases, and 70-75 kDa for latent collagenase. Further fractionation of high molecular weight proteases on Con A-Sepharose revealed that, unlike collagenase, chymotrypsin- and elastase-like proteases, the trypsin-like protease was bound by the affinity column. Native human placental type IV (basement membrane) collagen was degraded by chymotrypsin-like and elastase-like proteases but not by the trypsin-like protease. This degradation was inhibited by phenylmethyl sulfonyl fluoride and EDTA. The serine proteases also degraded efficiently denatured type I collagen. No correlation of the activities of trypsin-like protease and the other proteolytic enzymes was found in extracts of 18 individual gingival specimens. Significant correlation, however, was noted between collagenase and gelatinase. The gingival culture studies showed that, while the highest activity of the trypsin-, chymotrypsin-, and elastase-like enzymes were measured in medium during first days of the culture, collagenase and gelatinase activities increased up to the fourth day of culture and stayed high until the end of the culture. These results suggest that the neutral proteases that may participate in the periodontal tissue destruction are produced by different cell types of gingiva.

Topics: Chromatography, Affinity; Chromatography, Gel; Chronic Disease; Chymotrypsin; Collagen; Culture Techniques; Gingiva; Humans; Microbial Collagenase; Molecular Weight; Pancreatic Elastase; Periodontitis; Trypsin; Trypsin Inhibitors

Fecal chymotrypsin (FCT) has been measured by a new photometric method (Monotest Chymotrypsin; Boehringer, Mannheim) in 78 patients: 44 with chronic pancreatitis and 34 not affected by any pancreatic disease. The results were compared with those from other tests of pancreatic secretory (secretin-cerulein test) and digestive [serum and urinary p-aminobenzoic acid (PABA) and pancreolauryl] capacity. When FCT values were severely reduced (below 6.7 U/g), from 90 to 100% of the patients also presented abnormal pancreatic secretory and digestive capacity. On the other hand, 87% of the patients with normal FCT (above 20 U/g) presented normal secretory and digestive capacity. Patients with intermediate FCT values (between 6.7 and 20 U/g) showed normal or abnormal pancreatic secretory and digestive capacity with the same probability. Therefore, FCT, carried out as a first test, seems to identify subjects that need no further pancreatic function tests (normal and severely impaired FCT) and patients who need other more complex functional investigations (intermediate FCT values).

Topics: Biomarkers; Ceruletide; Chronic Disease; Chymotrypsin; Clinical Enzyme Tests; Duodenum; Feces; Humans; Pancreas; Pancreatic Function Tests; Pancreatitis; Reference Values; Secretin; Spectrophotometry

Topics: 4-Aminobenzoic Acid; Chronic Disease; Chymotrypsin; Evaluation Studies as Topic; Feces; Fluoresceins; Humans; Indicators and Reagents; Isoamylase; Lipase; Pancreas; Pancreatic Function Tests; Pancreatitis; Trypsin

Topics: Adult; Calcium; Chronic Disease; Chymotrypsin; Feces; Female; Humans; Male; Middle Aged; Pancreatitis; Vitamin D

Topics: Chronic Disease; Chymotrypsin; Feces; Humans; Pancreatitis

25 patients with chronic urticaria suspected to be of 'alimentary origin', were studied for a quantitative or qualitative deficiency of pancreatic enzyme secretion. All showed a normal fecal chymotrypsin excretion and 23/25 a normal bentiromide (PABA) and pancreolauryl test. In 2 females the urinary PABA and pancreolauryl tests were borderline pathological. This does not support the hypothesis that a pancreatic deficiency (of the kind which could be identified with the methods used) is associated with chronic urticaria in patients in whom improvement of urticaria occurs under a hydric or low antigenic diet.

Topics: 4-Aminobenzoic Acid; Chronic Disease; Chymotrypsin; Feces; Female; Fluorescein; Fluoresceins; Humans; Pancreas; Pancreatic Function Tests; para-Aminobenzoates; Urticaria

This study compares the diagnostic utility of fecal chymotrypsin (CT) output in timed stool collections and random stools using a new photometric enzyme assay. The CT output (mean +/- SD, U/24 h) was 1,487 +/- 1,980 in 127 children with normal fat absorption and negative sweat-chloride test (mean age 45 months), and 1,804 +/- 1,452 in 27 cases with fat malabsorption due to nonpancreatic disease (mean age 41 months). 66 cases of cystic fibrosis (CF) were examined (mean age 119 months). Stool output in 19 newly diagnosed patients before therapy was 85 +/- 94, in 42 patients receiving enzyme replacement therapy was 3,462 +/- 2,841, and in 5 patients with pancreatic sufficiency 1,754 +/- 1,482. Using nonparametric statistics, 120 U/24 h was defined as the lower limit of the 95-percentile for stool CT output. Only 5 of the 127 patients with normal fat absorption had output below that limit. None of the patients with nonpancreatic malabsorption and only 1 treated CF patient had lower values. Sixteen of the newly diagnosed CF patients had stool CT less than 120 U/24 h. The sensitivity of the test is therefore 84% and its specificity 97% at this decision threshold. However, no diagnostic advantage is gained from measuring CT output in timed stool collections as compared to random stools.

Topics: Age Factors; Child, Preschool; Chronic Disease; Chymotrypsin; Clinical Enzyme Tests; Cystic Fibrosis; Feces; Humans; Infant; Pancreatitis; Random Allocation; Time Factors

Over the last 10 years, a series of 144 consecutive patients with alcoholic recurrent pancreatitis have been studied prospectively at regular intervals with particular regard to exocrine function, calcifications, pancreatographic ductal changes, and histopathology of the pancreas. Based upon the long-term course, the patients were classified into two groups; group A (n = 95), those with chronic pancreatitis (78 of them with calcifications); and group B (n = 49), those with acute (nonprogressive) pancreatitis. The duration of disease from onset was 2-19 years (median, 9.7 and 8.3 years, respectively, in group A and B). The two groups were comparable at onset of the disease in age, sex, number of episodes of pancreatitis, and number of pseudocysts. In group A, all 95 cases fulfilled the strict diagnostic criteria of chronic pancreatitis within the period of observation (e.g., progressive exocrine insufficiency and/or typical morphological changes, particularly calcifications). In group B, the exocrine function remained normal over the entire period of observation. No histologic evidence of chronic pancreatitis was detected in five of seven large pancreatic specimens. Marked to moderate ductal changes were found in 10 of 16 patients in group B (despite normal exocrine function). Our data suggest that about one third of patients of the present series with alcoholic (recurrent) pancreatitis did not progress toward chronic (progressive) pancreatitis, although some demonstrated morphological alterations (except calcifications) in association with normally preserved exocrine function (residual scars?). The pathogenetic factor(s) responsible for progression (or nonprogression) of alcoholic (recurrent) pancreatitis to chronic pancreatitis remain(s) to be elucidated.

Topics: Acute Disease; Adult; Alcoholism; Calcinosis; Chronic Disease; Chymotrypsin; Feces; Female; Humans; Longitudinal Studies; Male; Middle Aged; Pancreas; Pancreatic Ducts; Pancreatic Pseudocyst; Pancreatitis; Prognosis; Prospective Studies; Recurrence

Chronic pancreatitis has been reported to be associated with an increased secretion of calcium in pancreatic juice. To determine whether estimation of duodenal calcium may be useful for diagnosing chronic pancreatitis, we compared duodenal calcium output in patients with chronic pancreatitis and in subjects without pancreatic disease, during intravenous infusion of secretion alone, with calcium, or with cholecystokinin-pancreozymin (CCK-PZ). Duodenal calcium output increased during infusion of both calcium and CCK-PZ to a similar extent in chronic pancreatitis and controls. Overall, duodenal output of chymotrypsin was markedly lower in chronic pancreatitis; however, chymotrypsin output increased in response to both intravenous calcium and CCK-PZ in both groups. Bilirubin output increased in both groups during calcium infusion, but this increase was significantly reduced in chronic pancreatitis; in contrast, CCK-PZ caused a similar increase in both groups. The high calcium output observed in hypercalcemia in the presence of low enzyme output suggests increased pancreatic secretion of enzyme-independent calcium in chronic pancreatitis. However, the difference is obscured by biliary calcium, which is secreted in much higher concentrations. Thus, duodenal calcium determination does not appear to be a useful diagnostic test in chronic pancreatitis.

Topics: Bilirubin; Calcium; Cholecystokinin; Chronic Disease; Chymotrypsin; Clinical Laboratory Techniques; Duodenum; Humans; Pancreatitis; Secretin; Spectrophotometry, Atomic

The advantages of the photometrical analysis of chymotrypsin in stool of dogs are: the short duration of procedure, the small amount of stool necessary and the simplified manner of measurement at 405 nm. The test was performed in healthy as well as in chronically pancreatic insufficient dogs and those with other origins of diarrhea. The normal value for healthy dogs was more than 1 U chymotrypsin/g stool. Because of distinct individual ranges of chymotrypsin activities a single detection is not sufficiently diagnostic. Several results below 1 U/g stool indicate a great likelihood of chronic pancreatic insufficiency.

Topics: Animals; Chronic Disease; Chymotrypsin; Dog Diseases; Dogs; Exocrine Pancreatic Insufficiency; Feces; Photometry

The intraluminal transport of cobalamin (Cbl) remains controversial in chronic pancreatitis. We have determined the ability of intestinal juice to degrade the digestive holohaptocorrin (R binder) and the binding of endogenous Cbl in basal intestinal juice from 22 chronic pancreatitis patients and 22 controls. The intestinal juice from patients and controls degraded 34.7 +/- 32.3% and 95.2 +/- 7.2% of holohaptocorrin, respectively. This percentage was correlated with the trypsin output but not with the Schilling test. The unsaturated Cbl-binding capacity was similar in both groups. Respectively, 62.5 +/- 26.6% and 19.6 +/- 11.7% of endogenous Cbl was bound to haptocorrin in intestinal juice from patients and controls. These percentages were correlated with the Schilling test and with the ability of intestinal juice to degrade haptocorrin. We concluded that 1) the sequestration of Cbl to haptocorrin is one of the factors responsible for the malabsorption of crystalline Cbl in patients with chronic pancreatitis and 2) enterohepatic circulation of Cbl can be interrupted in some cases of chronic pancreatitis.

Topics: Adult; Aged; Chronic Disease; Chymotrypsin; Corrinoids; Humans; Intestinal Secretions; Intrinsic Factor; Malabsorption Syndromes; Middle Aged; Pancreatitis; Schilling Test; Trypsin; Vitamin B 12

Discriminant analysis was used to interpret the results of the secretin-cholecystokinin (CCK) test in the diagnosis of chronic pancreatitis. An allocation rule based on the use of two test variables--mean chymotrypsin concentration and peak bicarbonate output--was constructed to distinguish between 63 patients with chronic pancreatitis and 68 patients without organic disease. These latter patients had signs and symptoms similar to those of the patients with chronic pancreatitis and were used as controls. The allocation rule was applied to a larger set of individuals, including 105 patients with various other diseases. The sensitivity of the test was 83%, and the specificity was 89%. With a prevalence of chronic pancreatitis of 27% in this set of individuals, the positive predictive value was 73%, the negative predictive value was 93%, and the accuracy rate 87%. This diagnostic performance of the secretin-CCK test gives the test a meaningful place in the examination of patients suspected of having chronic pancreatitis.

Topics: Adult; Bicarbonates; Cholecystokinin; Chronic Disease; Chymotrypsin; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Pancreatitis; Secretin; Statistics as Topic

Topics: Adult; Cholangiopancreatography, Endoscopic Retrograde; Chronic Disease; Chymotrypsin; Feces; Female; Humans; Male; Middle Aged; Pancreatic Function Tests; Pancreatitis

Topics: Acute Disease; Adult; Aged; Calcinosis; Chronic Disease; Chymotrypsin; Feces; Female; Humans; Male; Middle Aged; Pancreatitis

Topics: 4-Aminobenzoic Acid; Chronic Disease; Chymotrypsin; Exocrine Pancreatic Insufficiency; Feces; Humans

We examined the maximal serum PABA concentration within 3 hrs (MS-PABA) and the 6 hr urinary PABA recovery (6 hr U-PABA) after BT-PABA administration, PABA excretion index, and chymotrypsin secretory response to caerulein-secretin stimulation in ten control subjects and fifteen patients with chronic pancreatitis diagnosed on the basis of pancreatograms. The results suggested that MS-PABA can distinguish the patients with definite irregular dilatation of the main pancreatic duct from the controls, but not those with localized irregular dilatations of the side branches from the controls. MS-PABA showed a significant correlation with 6 hr U-PABA, PABA excretion index, chymotrypsin output and bicarbonate output. This modified method was shown to be useful in the diagnosis of chronic pancreatitis with unequivocally abnormal pancreatograms and/or markedly decreased chymotrypsin secretion. This modification will serve to simplify the BT-PABA test by eliminating urinary collection and shortening the procedure time.

Topics: 4-Aminobenzoic Acid; Adult; Aminobenzoates; Bicarbonates; Ceruletide; Chronic Disease; Chymotrypsin; Female; Humans; Male; Middle Aged; Pancreatitis; para-Aminobenzoates; Secretin

In 11 persons with normal pancreas function and 21 patients with chronic pancreatitis serum levels of insulin and C-peptide were measured under basal conditions and after maximal stimulation with glucose-tolbutamide-glucagon. Patients with the highest excretory deficiency in the secretin-pancreozymin test had the most marked impairment in endocrine function. In patients with manifest diabetes the exocrine capacity was reduced to an average of 10% of normal. The endocrine parameters correlated linearly with the exocrine ones, most markedly C-peptide reserve with pancreatic enzyme secretion.

Topics: Adult; C-Peptide; Chronic Disease; Chymotrypsin; Diabetes Mellitus; Female; Humans; Insulin; Male; Pancreas; Pancreatitis; Trypsin

The degree of correlation between exocrine pancreatic function and endocrine secretory capacity was examined in 13 chronic pancreatitis patients with secondary diabetes mellitus, 8 chronic pancreatitis patients without diabetes, and 11 healthy subjects. The two parameters were studied under maximal stimulation (volume-corrected secretin-pancreozym test and glucose-tolbutamide-glucagon provocation, respectively). A close, linear correlation was found between all endocrine variables and pancreatic acinar function (e.g. rs = 0.77 for chymotrypsin output and C-peptide release; p less than 0.0001). The correlation was less strong with pancreatic bicarbonate output (e.g. rs = 0.49 for C-peptide release; p less than 0.05). In our patients, secondary overt diabetes occurred in chronic pancreatitis when protease outputs were, on an average, reduced to about 10% of the mean maximal protease output of normal subjects.

Topics: Adult; C-Peptide; Chronic Disease; Chymotrypsin; Diabetes Mellitus, Type 2; Female; Humans; Insulin; Insulin Secretion; Islets of Langerhans; Male; Pancreatic Function Tests; Pancreatic Hormones; Pancreatitis

Topics: Chronic Disease; Chymotrypsin; Clinical Enzyme Tests; Duodenum; Feces; Humans; Pancreatitis; Trypsin

Fecal chymotrypsin (FCT) was determined in stool specimens of healthy children and those with gastro-intestinal disease, by a new photometric method. The values are comparable with chymotrypsin concentrations found by pH-stat method. The new test is cheap, reliable and easy to perform. For this reasons and for the sensitivity of all tubeless pancreatic function tests (NBT-PABA, FDL, FCT) is rather low (60-70%), the FCT-test may be preferred as diagnostic marker for differential diagnosis of exocrine pancreatic insufficiency.

Topics: Child; Child, Preschool; Chronic Disease; Chymotrypsin; Cystic Fibrosis; Feces; Humans; Infant; Infant, Newborn; Pancreatitis; Photometry

The purpose of this report is to evaluate whether a new, simple, non-invasive method for chymotrypsin measurement in stools is useful for the diagnosis of exocrine pancreatic insufficiency in cystic fibrosis (CF). A hundred children aged from 2 months to 12 years were tested: 50 children had been admitted for chronic diarrhoea, 15 for cystic fibrosis and 40 acted as controls. Chymotrypsin in stools was assayed using a kinetic measurement with Succ-Ala-Ala-Pro-Phe-pNa as substrate in a simple photometric assay. In 13 of 15 children with cystic fibrosis, stool enzyme levels were always remarkably low, while all control subjects and all children not presenting cystic fibrosis had normal stool levels of chymotrypsin. Our data suggest that stool chymotrypsin measurement is a simple and reliable "tubeless" test for the evaluation of exocrine pancreatic insufficiency in children with cystic fibrosis.

Topics: Child; Child, Preschool; Chronic Disease; Chymotrypsin; Clinical Enzyme Tests; Cystic Fibrosis; Diarrhea; Feces; Humans; Infant; Pancreas; Reference Values

Lactoferrin (LF), chymotrypsin and lipase activity were measured in duodenal juice during pancreatic stimulation. Secretin (0.5 CU/kg/h) plus cerulein (75 ng/kg/h) were infused intravenously in 98 subjects: 33 patients without organic diseases (C), 40 patients affected by chronic pancreatitis (CP), and 25 patients with different gastrointestinal diseases (GID). LF was determined by means of a new noncompetitive immunoenzymatic assay with a sensitivity in the duodenal juice of 5 ng/ml. Duodenal LF concentrations were significantly higher in CP than in C or GID (p less than 0.001). LF was in a normal range in acute relapsing pancreatitis due to biliary stones or pancreas divisum. In the diagnosis of the chronic pancreatitis, LF/lipase ratios showed a specificity of 93% and a sensitivity of 95%. Our results show that LF immunoassay in duodenal juice is a sensitive and accurate assay to apply in pancreatic function tests involving duodenal content analysis.

Topics: Adult; Body Fluids; Ceruletide; Chronic Disease; Chymotrypsin; Duodenum; Female; Gastrointestinal Diseases; Humans; Lactoferrin; Lactoglobulins; Lipase; Male; Middle Aged; Pancreatitis; Secretin

The purposes of this study were to (a) evaluate the effect of pancreatic extract administered to patients with chronic pancreatitis and recurrent abdominal pain in a placebo-controlled, double-blind crossover study, (b) investigate the effects of acute intraduodenal pancreatic enzyme perfusion on pancreatic secretion, and (c) assess the effect of chronic, noninterrupted pancreatic extract administration on basal and stimulated pancreatic secretion. These studies demonstrated that pancreatic extract decreases abdominal pain and that intraduodenal perfusion with proteases but not with amylase or lipase suppresses pancreatic exocrine secretion in patients with chronic pancreatitis. Chronic administration of pancreatic extract to patients with chronic pancreatitis decreased both basal and stimulated pancreatic exocrine secretion.

Topics: Abdomen; Adult; Aged; Amylases; Chronic Disease; Chymotrypsin; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Male; Middle Aged; Ovomucin; Pain; Pancreas; Pancreatic Extracts; Pancreatitis; Perfusion; Placebos; Trypsin

The changes in the residual function of the exocrine pancreas before and after the operation for chronic pancreatitis were examined with N-benzoyl-L-tyrosyl-p-aminobenzoic acid (NBT-PABA test) in 15 patients. The results of the NBT-PABA test classified by the surgical formula proved that no significant difference was found between the pancreatectomized group (pancreaticoduodenectomy and distal pancreatectomy) and the decompression group (pancreatojejunostomy and transduodenal exploration of the pancreatic duct), and no improvement on the outcome of the postoperative NBT-PABA test, as compared with the outcome of the preoperative test, was noted in both groups. When the state of the fibrosis of the pancreas was classified by the grade for comparison, it was observed that the outcome of the NBT-PABA test of grade 1, in which little fibrosis was made, was better than the outcome of the test of grade 3 before operation (p less than 0.01) and after operation (p less than 0.01). In each of the grades, however, no difference was found between the outcome of the preoperative NBT-PABA test, and that of the postoperative test. It was presumed from these findings that the residual function of the exocrine pancreas after operation was dependent largely on the degree of pancreatic fibrosis at operation.

Topics: 4-Aminobenzoic Acid; Adult; Aminobenzoates; Chronic Disease; Chymotrypsin; Humans; Middle Aged; Pancreas; Pancreatic Function Tests; Pancreatitis; para-Aminobenzoates

Assessment of the clinical value of the pancreolauryl test (PLT) in the literature range from "useless" to a specifity of 95% and a sensitivity of 98%. In this work, our own data are presented in relation to various reference methods. The results are derived from the largest collective investigated to data, comprising 40 controls and 391 patients (108 with chronic pancreatitis and 283 with other gastrointestinal disorders). The specifity of the the PLT varies between 81% and 95% according to the "quality" of the control collective. The PLT is particularly frequently pathological in patients with diseases in the region of the gallbladder/bile duct and the gastrointestinal tract. The sensitivity of the PLT for chronic pancreatitis varies between 68% and 100%, depending on 9 different reference methods employed. Based on the prevalence of chronic pancreatitis with exocrine insufficiency in various patient collectives, the predictive value of the PLT for the presence of this disorder can be calculated using our data.

Topics: Cholangiopancreatography, Endoscopic Retrograde; Cholecystokinin; Cholelithiasis; Chronic Disease; Chymotrypsin; Diagnosis, Differential; Exocrine Pancreatic Insufficiency; Gastrointestinal Diseases; Humans; Liver Diseases; Pancreatic Diseases; Pancreatic Function Tests; Pancreatitis; Secretin; Tomography, X-Ray Computed

In this new photometric assay fecal samples are pretreated with detergent and high concentrations of salts. The subsequent kinetic enzyme determination step involves the chromogenic substrate succinyl-Ala-Ala-Pro-Phe-4-nitroanilide. The sample pretreatment assures a nearly complete solubilization of the formerly particle-bound enzyme, thus permitting determination of the enzyme activity in either the suspension or the supernate after centrifugation. Furthermore this pretreatment enhances the enzyme activity and decreases the Km value. Results by this assay correlate well with those by classical titrimetry and the method is easily adapted to automated systems.

Topics: Autoanalysis; Buffers; Calcium Chloride; Chromogenic Compounds; Chronic Disease; Chymotrypsin; Feces; Humans; Hydrogen-Ion Concentration; Oligopeptides; Pancreatitis; Quaternary Ammonium Compounds; Reference Values; Sodium Chloride; Solubility; Spectrophotometry

20 patients with chronic staphylococcal osteomyelitis were tested for 6 acute phase reactants: alpha 1-antitrypsin, orosomucoid, haptoglobin, ceruloplasmin, C-reactive protein (CRP) and antichymotrypsin during different phases of the disease. CRP was best correlated to clinical activity and in 3 cases CRP and ceruloplasmin increased a few weeks before a clinically apparent exacerbation of the osteomyelitis took place. A Latex-CRP slide method showed fairly good agreement with CRP assessed by immunoassay. Determination of CRP is a suitable test for following the activity of chronic osteomyelitis.

Topics: alpha 1-Antichymotrypsin; alpha 1-Antitrypsin; Alpha-Globulins; C-Reactive Protein; Ceruloplasmin; Chronic Disease; Chymotrypsin; Haptoglobins; Humans; Immunoassay; Latex; Male; Orosomucoid; Osteomyelitis; Prospective Studies; Staphylococcal Infections; Trypsin Inhibitors

A quantitative correlation between computer-tomographic (CT) findings and exocrine pancreatic function following secretin-ceruletide stimulation was performed in 48 patients with chronic pancreatitis; thereby a significant correlation between the degree of morphological changes in CT and the stage of functional impairment was found (r = 0,7841, p less than 0,001). Bicarbonate secretion/h showed the strongest correlation to CT findings (r = -0,7193, p less than 0,001) within the single functional parameters. CT showed a limited sensitivity (50%) in detecting chronic pancreatitis in cases with a slight functional impairment (stage 1). Morphological signs as calcifications, pancreatic duct ectasia were constantly coupled with a severe degree of functional impairment, whereas enlargement and cysts were found throughout the different functional stages.

Topics: Adult; Aged; Amylases; Bicarbonates; Ceruletide; Chronic Disease; Chymotrypsin; Exocrine Pancreatic Insufficiency; Female; Humans; Male; Middle Aged; Pancreas; Pancreatitis; Secretin; Tomography, X-Ray Computed; Trypsin

Twenty-five patients with chronic pancreatitis and 25 patients with non-pancreatic abdominal disorders were investigated by Lundh and BT PABA/14C-PABA tests of pancreatic function. The following results emerged: (1) There was a strong positive linear relationship between mean trypsin activity (MTA) and mean chymotrypsin activity (MCA) in duodenal aspirates after a Lundh test meal. (2) There was a strong positive linear relationship between chymotrypsin activity measured with BTEE, or BT PABA as substrate. (3) There was a strong positive correlation between MTA, or MCA, in duodenal juice after a Lundh meal and urinary PABA recovery, or the PABA/14C excretion index (PEI) in patients with chronic pancreatitis, but not in controls. (4) There was no correlation between the pH of duodenal juice in Lundh tests and PABA recovery, or PEI, in patients with or without pancreatic disease. We conclude that the Lundh and BT PABA/14C-PABA tests are equally discriminatory methods of assessing pancreatic exocrine function. The rate limiting effect of pH on BT PABA hydrolysis reported in in-vitro studies does not affect the practical clinical value of the BT PABA/14C-PABA test.

Topics: 4-Aminobenzoic Acid; Aminobenzoates; Chronic Disease; Chymotrypsin; Duodenum; Humans; Hydrogen-Ion Concentration; Pancreatic Function Tests; Pancreatitis; para-Aminobenzoates; Trypsin

The sensitivity and specificity of the pancreolauryl test was evaluated in comparison with the NBT-PABA test, the estimation of fecal chymotrypsin and fat, and the secretin-pancreozymin test in 168 patients with and without pancreatic disease. The overall sensitivity rate was as follows: pancreolauryl test 90%, NBT-PABA test 86%, fecal chymotrypsin 66%. In patients with pancreatic steatorrhea the sensitivity of the pancreolauryl test was 100%, the NBT-PABA test 97%, and the fecal chymotrypsin estimation 92%. The specificity of these tests was: pancreolauryl test 97.6%, fecal chymotrypsin 87%, and NBT-PABA test 81.8%. The pancreolauryl test may be recommended as a noninvasive easy-to-perform tubeless pancreatic function test with a sufficiently high sensitivity and specificity.

Topics: 4-Aminobenzoic Acid; Cholecystokinin; Chronic Disease; Chymotrypsin; Feces; Fluoresceins; Humans; Nitroblue Tetrazolium; Pancreatic Function Tests; Pancreatitis; Secretin

The variability of sputum sol phase proteins was studied in 27 patients with stable chronic obstructive bronchitis. Within individual patients (n 1/2 11), variability over 5 consecutive days was similar for each of 4 proteins studied: average coefficient of variation (CV) for albumin was 39.8% for alpha 1-antitrypsin (alpha 1AT), 32.1%, for alpha 1-antichymotrypsin (alpha 1ACh), 26.6%, and for immunoglobulin A (IgA), 35.1%. The calculation of sputum-to-serum ratios did not affect this variability. Between patients (all patients studied on a single day) the variability of sputum sol phase proteins was greater (CV: albumin 1/2 84.5%, alpha 1AT 1/2 90.1%, alpha 1ACh 1/2 58.3%, and IgA 1/2 71.6%) and was also unaffected by the use of sputum-to-serum concentration ratios. "Standardization" for albumin reduced the average within-patient variability for sputum alpha 1AT (CV from 32.1 to 19.7%) but it had no effect on alpha 1ACh and IgA. However, although between-patient CV for sputum alpha 1AT was also reduced (from 90.1 to 53.4%, 2 p less than 0.01) it significantly increased for alpha 1ACh (from 58.3 to 86.0%, 2 p less than 0.05) and IgA (71.6 to 170.1%, 2 p less than 0.001), suggesting that such standardization may be inappropriate for these proteins.

Topics: Aged; Albumins; alpha 1-Antichymotrypsin; alpha 1-Antitrypsin; Blood Proteins; Bronchitis; Chronic Disease; Chymotrypsin; Colloids; Female; Humans; Immunoglobulin A, Secretory; Lung Diseases, Obstructive; Male; Middle Aged; Proteins; Reference Standards; Sputum; Trypsin Inhibitors

Two forms of alpha 1-proteinase inhibitor (alpha 1-PI) were characterized in the pancreatic juice of patients with chronic pancreatitis, one free form and one form complexed with a proteinase. This complex is probably present in minute amounts in normal pancreatic juice which contains mainly free alpha 1-PI. The proteinase bound to alpha 1-PI has been identified as chymotrypsin A and the inhibitory activity of the free form of alpha 1-PI has been demonstrated. These data underline the rapid conversion of human proteolytic zymogens into active enzymes and demonstrate the increase of this activation phenomenon in the juice of patients with chronic pancreatitis.

Topics: alpha 1-Antitrypsin; Blood Proteins; Chronic Disease; Chymotrypsin; Humans; Immunoelectrophoresis, Two-Dimensional; Pancreatic Juice; Pancreatitis

We studied the effect of bombesin (9 ng/kg X min for 30 min by intravenous infusion) on serum immunoreactive trypsin in healthy subjects and in chronic pancreatitis patients. Bombesin administration caused a marked and significant increase of serum immunoreactive trypsin concentration in healthy subjects. The increase occurred in the first 15 min after the beginning of bombesin infusion and persisted for the duration of the study (2 h). In patients with chronic pancreatitis, the increase was much less pronounced. In these patients, the integrated immunoreactive trypsin response to bombesin was significantly correlated with bicarbonate, lipase, and chymotrypsin outputs into the duodenum. The response of serum immunoreactive trypsin to bombesin stimulation seems to vary according to the degree of pancreatic exocrine dysfunction and to reflect the functional capacity of acinar cell mass.

Topics: Adult; Aged; Bicarbonates; Bombesin; Chronic Disease; Chymotrypsin; Duodenum; Female; Humans; Infusions, Parenteral; Intubation, Gastrointestinal; Lipase; Male; Middle Aged; Pancreas; Pancreatitis; Peptides; Trypsin

The present study has been designed to work out the factors regulating the fasting serum levels of trypsin-like immunoreactivity in chronic pancreatitis. One hundred patients with chronic pancreatitis have been included and studied during a painless phase of the disease. No relationships have been observed between serum trypsin-like immunoreactivity and the presence of pancreatic calcifications. Serum immunoreactive trypsin levels showed a gradual decline parallel to the progressive impairment of bicarbonate and enzyme (trypsin and chymotrypsin) outputs in duodenal aspirates during pancreatic secretory studies. Therefore, serum trypsin-like immunoreactivity levels are thought to reflect the functional capacity of the exocrine pancreas. Reduced levels of trypsin-like immunoreactivity were detected in almost all patients with diabetes and steatorrhea. However, the finding of low levels also in a minority of chronic pancreatitis patients with normal endoscopic retrograde cholangiopancreatography or pancreatic secretory tests points to other factors which, in addition to the atrophy of the pancreatic parenchyma, may influence the circulating levels of trypsin-like immunoreactivity in chronic pancreatitis.

Topics: Antigens; Celiac Disease; Cholangiopancreatography, Endoscopic Retrograde; Chronic Disease; Chymotrypsin; Diabetes Complications; Humans; Pancreatitis; Trypsin

The diagnostic value of the fecal chymotrypsin test (FCT) was reevaluated with regard to (a) proved pancreatic hypofunction of different severity (183 pancreozymin-secretin tests); (b) the final clinical diagnosis, and (c) fecal fat excretion (208 patients with chronic pancreatitis; CP). Progressive pancreatic disease (cancer, CP) was mainly associated with moderate or severe pancreatic hypofunction (119/138; 86.2%) and a low incidence of false-normal FCT values (14/138; 10.1%). Miscellaneous disorders (mainly reversible pancreatic hypofunction) were mainly associated with slight pancreatic hypofunction and a high incidence of false-normal FCT values (17/45; 37.8%). Pancreatic steatorrhea (greater than 10 g/day) was found only in patients with markedly depressed FCT values. Progressive deterioration of pancreatic function was demonstrated by repeated FCT in CP (n = 220).

Topics: Celiac Disease; Cholecystokinin; Chronic Disease; Chymotrypsin; Exocrine Pancreatic Insufficiency; False Negative Reactions; Feces; Humans; Lipids; Pancreatic Function Tests; Pancreatitis; Secretin

Lactoferrin is a non-enzymatic secretory protein of human pancreas and is specifically increased in pancreatic juice of patients with chronic pancreatitis. Duodenal contents being easier to obtain than pure pancreatic juice, the possibility of using lactoferrin measurement in duodenal juice as a diagnosis test for chronic pancreatitis was explored. Forty-eight patients were studied. Duodenal juice was obtained devoid of salivary contamination by a special double lumen tube. Under these conditions lactoferrin secretion (concentration and output) is increased in patients with chronic pancreatitis. When expressed as the ratio of lactoferrin to lipase units, there was no overlap between chronic pancreatitis and other pancreatic disease or controls. The simplicity and the reproducibility of the technique on a material as readily available as duodenal juice confirms the diagnostic value of lactoferrin measurement in the assessment of patients with suspected pancreatic disease.

Topics: Adult; Aged; Chronic Disease; Chymotrypsin; Duodenum; Female; Humans; Intestinal Secretions; Lactoferrin; Lactoglobulins; Lipase; Male; Middle Aged; Pancreatitis; Phospholipases

The diagnostic aids of acute pancreatitis include the clinical presentation, laboratory investigations and abdominal sonography. The assessment of amylase creatinin clearance ratio is not superior to simple amylase estimations in identifying unspecific hyperamylasemias apart from acute pancreatitis. The management of acute pancreatitis consists of a standardized basic treatment which does not depend on the degree of the severity of the disease and supplementary measures which are adjusted to the degree of severity and complications. In case of chronic pancreatitis a variety of indirect and direct morphological and functional examinations are available. The diagnostic safety of all procedures--each taken by its own--is below 90%; however, the combined use has to be adjusted to the severity of the symptoms suspicious of pancreatis disease. The therapeutic goal includes the conservative management of the painful recurrences to achieve transmission into the final stage of the disease which presents only minor symptoms. Operation has to be considered in case of untreatable pain and local complications. The obstruction of the pancreatic duct by means of synthetic glue instillations is a hopeful approach.

Topics: Acute Disease; Calcitonin; Carcinoma; Chronic Disease; Chymotrypsin; Humans; Hypocalcemia; Middle Aged; Pancreas; Pancreatic Neoplasms; Pancreatitis; Tomography, X-Ray Computed; Ultrasonography

Forty-eight patients with chronic recurrent pancreatitis treated by resection of the head of the pancreas were restudied more than a year post-operatively. In addition to general features such as symptoms, alcohol consumption and work ability, faecal weight, its fat content, fat and fatty acid balance and faecal chymotrypsin were measured. According to the patients' own estimate, late results were good or very good in 70-90%. Faecal fat content and balance indicated high-grade exocrine pancreatic insufficiency in 80 and 90%, respectively. But it was easily controlled by drugs. In a third of the cases there was the need to supplement the diet with medium-chain triglycerides. Its components are satisfactorily absorbed even when the fat utilisation is severely abnormal.

Topics: Chronic Disease; Chymotrypsin; Duodenum; Exocrine Pancreatic Insufficiency; Feces; Humans; Lipids; Pancreatectomy; Pancreatitis; Postoperative Complications

Established and modern methods for assessment of exocrine pancreatic function are reviewed and discussed with regard to diagnostic workup in chronic pancreatitis. Determination of chymotrypsin in stool or oral admit BT-PABA suffice as screening methods, while more sensitive methods such as Lundh test, secretin, or secretin/pancreozymin are suitable for confirmation of diagnosis.

Topics: 4-Aminobenzoic Acid; Cholecystokinin; Chronic Disease; Chymotrypsin; Feces; Humans; Pancreatitis; Secretin

Topics: Adult; Amylases; Carboxypeptidases; Chronic Disease; Chymotrypsin; Clinical Enzyme Tests; Deoxyribonucleases; Humans; Lipase; Liver Cirrhosis; Pancreas; Pancreatic Diseases; Pancreatic Neoplasms; Pancreatitis; Ribonucleases; Trypsin

32 patients with proven chronic pancreatitis and 56 controls without evidence of pancreatic disease were studied by the PABA test, the fecal chymotrypsin method and the fecal fat method. The sensitivity of the fecal chymotrypsin method for detection of pancreatic disease was significantly higher (p less than 0.005). The sensitivity of the PABA test and the fecal fat method were comparable. The specificity of the PABA test and the fecal chymotrypsin method was of the same order.

Topics: 4-Aminobenzoic Acid; Aminobenzoates; Chronic Disease; Chymotrypsin; Fats; Feces; Female; Humans; Male; Pancreas; Pancreatitis; Reference Values; Time Factors

Not infrequently exact diagnosis of chronic pancreatitis is possible only after step by step observation. The results of examination, analyses and treatment should be communicated from a general practitioner to a specialist, further to a specialized centre and vice versa. Screening tests and special examinations should be conducted in definite order. A surgical treatment is desirable in approximately 40% of clinically pronounced chronic pancreatitis. The best results are obtained by close cooperation between different specialists and the patient himself.

Topics: 4-Aminobenzoic Acid; Alcoholism; Amylases; Chloroquine; Chronic Disease; Chymotrypsin; Diabetes Mellitus; Feces; Humans; Isoenzymes; Ligation; Lipase; Nutritional Physiological Phenomena; Pancreatic Ducts; Pancreatitis; Patient Care Team

Topics: Calcinosis; Chronic Disease; Chymotrypsin; Humans; Lipase; Pancreatic Juice; Pancreatitis; Trypsin

To evaluate the predictive value of the evocative test (E.T.) in the diagnosis of pancreatitis, the E.T. was performed in 35 healthy subjects (group I), 65 patients with a presumptive clinical of chronic pancreatitis (group II), and 52 patients with proved chronic pancreatitis (group III). In group I, false positive results were obtained in 11,4% of the patients, the increase in lipase above the upper limit of normal was relatively small. The patients of group II gave abnormal E.T.'s in 63%, reduced faecal chymotrypsin activities being found in 40%, and steatorrhea in 28% of the cases. Positive E.T.'s were associated with abnormal chymotrypsin and faecal fat determinations in 51% and 27%, respectively. In group III,, a positive E.T. was obtained in 60%, the test results show a signifikant negative correlation with the extent of pancreatic exocrine insufficiency. In group of patients with confirmed chronic pancreatitis but without steatorhea, the E.T. was positive in 72%. The E.T. has a limited value in the diagnosis of early stages of chronic pancreatitis.

Topics: Chronic Disease; Chymotrypsin; Clinical Enzyme Tests; False Positive Reactions; Feces; Humans; Lipase; Lipids; Pancreatitis

I assayed 16 commercially available pancreatic extracts (representing capsules, tablets and enteric-coated tablets) for enzyme activities and the relation between the in vitro activities and in vivo potency evaluated in man. Lipase activity ranged from 10 to 3600 units per unit, with 11 preparations containing less than 600 units per unit. The preparations with the highest lipase activities were llozyme, 3600, Kuzyme HP, 2330, Festal, 2073, Cotazym, 2014, and Viokase, 1636 units. Lipase activity in vitro correlated with potency in vivo for tablets and capsules, with tablets and capsules being effective in reducing steatorrhea by 56.1 +/- 9 per cent and 48.6 +/- 10 per cent (mean +/- S.E.M.) respectively, P less than 0.001. Enteric-coated tablets were less effective (20 +/- 13 per cent reduction, P greater than 0.02). The longer the gastric pH remained greater than or equal to 4 (r = 0.915, P less than 0.01) and the higher the average duodenal pH (r = 0.966, P less than 0.01), the more marked the reduction in steatorrhea.

Topics: Administration, Oral; Biological Availability; Capsules; Celiac Disease; Chronic Disease; Chymotrypsin; Duodenum; Feces; Female; Gastric Mucosa; Humans; Hydrogen-Ion Concentration; In Vitro Techniques; Lipase; Male; Nitrogen; Pancreas; Pancreatic Diseases; Pancreatic Extracts; Pancreatic Juice; Tablets; Tablets, Enteric-Coated

Topics: Chronic Disease; Chymotrypsin; Feces; Humans; Methods; Pancreatic Diseases

The effect of maximal doses of cholecystokinin and caerulein on lipase and chymotropsin concentrations were compared in large groups of patients with almost equal capacities of bicarbonate secretion. The responsiveness of the pancreas is, as a whole, higher with caerulein than with cholecystokinin, this feature being specially evident in patients with chronic calcifying pancreatitis.

Topics: Bicarbonates; Ceruletide; Cholecystokinin; Chronic Disease; Chymotrypsin; Duodenum; Humans; Lipase; Pancreas; Pancreatitis

97 chronic alcoholic patients were investigated with regard to exocrine pancreatic function. Chronic calcifying pancreatitis was radiologically established in 7.2% of the cases. Secretin-pancreozymin tests were performed in 30 patients. Pancreatic insufficiency was found in 8 patients, while 8 patients showed marked hypersection. The daily faecal fat excretion in 10 other patients with partial gastrectomy and Billroth II operation was 5.3 g. Pancreatic disorders were, thus, detected in 53.2% cases of chronic alcoholism. This is higher than expected for Austria.

Topics: Adult; Alcoholism; Austria; Bicarbonates; Chronic Disease; Chymotrypsin; Female; Humans; Male; Middle Aged; Pancreas; Pancreatic Juice; Pancreatitis; Trypsin

Fecal chymotrypsin determination and secretin-pancreozymin test with volume-loss corrected were carried out intra-individually on 57 clinically normal test subjects and 51 patients with chronic pancreatic disease. A good correlation could be established in every case between the chymotrypsin activity in stool and the chymotrypsin output in the duodenal aspirate. False-positive chymotrypsin activity was not to be found in healthy subjects. On the other hand, however, the chymotrypsin activity in stool compared with the result of the secretin-pancreozymin test was found to be false negative in 21% of all patients with chronic pancreatic disease (some or all parameters pathological). In patients with a clear deficiency in the exocrine function of pancreas (all parameters pathological) the chymotrypsin activity was nevertheless seen to be false-negative in only 9.9% of the cases. Thus the fecal chymotrypsin determination can be used as screening test for the clearly reduced pancreatic exocrine insufficiency.

Topics: Adult; Cholecystokinin; Chronic Disease; Chymotrypsin; False Negative Reactions; Feces; Female; Humans; Male; Pancreatitis; Secretin

Topics: Acute Disease; Adult; Aged; Chronic Disease; Chymotrypsin; Female; Femoral Artery; Humans; Infusions, Intra-Arterial; Male; Middle Aged; Thrombophlebitis; Trypsin

Exocrine pancreatic function has been evaluated in 24 controls and 29 patients with confirmed chronic pancreatitis by continuous infusion (90 min) of synthetic caerulein, 100 ng/kg/h, plus GIH secretin, 1 CU/kg/h. Mean secretory values of the controls were comparable to those obtained by others using maximal doses of secretin and CCK. Unlike the controls, patients suffering from chronic pancreatitis demonstrated a progressive reduction in secretion during infusion. Thus, the comparison of responses for the final 30-min period gave much clearer and more complete discrimination between normal and abnormal pancreatic function than the preceding 30-min period.

Topics: Adolescent; Adult; Bicarbonates; Ceruletide; Chronic Disease; Chymotrypsin; Female; Humans; Injections, Intravenous; Lipase; Male; Middle Aged; Pancreas; Pancreatitis; Secretin; Secretory Rate; Trypsin

Topics: Adult; Aged; Chronic Disease; Chymotrypsin; Feces; Female; Humans; Male; Middle Aged; Neoplasm Metastasis; Pancreatic Diseases; Pancreatic Neoplasms; Pancreatitis

Good therapeutic results free of unwanted side-effects were observed in the management of acute and chronic non-tubercular bronchopneumopathies with an association of tetracyclin hydrochloride, proteolytic enzymes (trypsin and chymotrypsin), vanillic acid diethylamide and pyridophyllin.

Topics: Acute Disease; Adolescent; Adult; Aged; Bronchitis; Bronchopneumonia; Chronic Disease; Chymotrypsin; Drug Combinations; Drug Evaluation; Female; Humans; Lung Abscess; Lung Diseases; Male; Middle Aged; Tetracycline; Trypsin

The hypothesis that deficiencies of plasma protease inhibitors might play a role in the pathogenesis of chronic urticaria was evaluated. Plasma levels were measured in patients with urticaria and a matched control group for alpha1-antitrypsin, alpha2-macroglobulin, total trypsin-inhibiting capacity, kallikrein-inhibiting capacity, and the complement factors C1 esterase inhibitor, C3, and C4. A total of 92 patients with chronic urticaria or more than three months' duration was studied. Patients with acquired cold urticaria had significantly decreased levels of alpha1-antitrypsin and total antitrypsin activity. In patients with acquired angioneurotic edema, alpha1-antitrypsin levels and antichymotrypsin activities were lowered, with less significant decreases in anti-trypsin and antikallikrein activities. Levels of C1 esterase inhibitor , C3, and C4 were normal in all groups. There was no correlation between the increased sensitivity to intracutaneously administered kallikrein injection and deficiencies of of protease inhibitors.

Topics: Adolescent; Adult; Aged; alpha 1-Antitrypsin; alpha-Macroglobulins; Angioedema; Child; Chronic Disease; Chymotrypsin; Complement C1 Inactivator Proteins; Complement C3; Complement C4; Esterases; Female; Humans; Kallikreins; Male; Middle Aged; Protease Inhibitors; Skin Tests; Urticaria

1. A simple, highly sensitive, specific fluorometric method for the determination of chymotrypsin is described. 2. The new substrate utilized in this assay, N-glutaryl-glycyl-glycyl-l-phenylalanine beta-naphthylamide (GGPNA), is readily soluble in water, stable and highly specific for chymotrypsin. It is not degraded by a large excess of carboxypeptidase B, elastase, thrombin or plasmin and is virtually resistant to trypsin. 3. GGPNA is extremely sensitive to the action of chymotrypsin and permits detection of enzyme concentrations as low as 1 ng/ml. Linearity between enzyme concentration and fluorescence produced is maintained up to at least 3000 ng/ml. 4. alpha2-Macroglobulin-bound chymotrypsin hydrolyzes GGPNA at a rate about 2/3 of that exhibited by the free enzyme. 5. Bile pigments in amounts normally found in duodenal juice or traces of blood do not interfere with the assay. 6. GG PNA which releases beta-naphthylamine upon hydrolysis is suitable also for colorimetric and histological determination of chymotrypsin.

Topics: Bilirubin; Chronic Disease; Chymotrypsin; Hemoglobins; Humans; Hydrogen-Ion Concentration; Kinetics; Macroglobulins; Methods; Microchemistry; Naphthols; Oligopeptides; Pancreatic Neoplasms; Pancreatitis; Protein Binding; Spectrometry, Fluorescence

A specific substrate (Suphepa), which is well known in duodenal chymotrypsin determination (pancreozymin-secretin-test), is also suitable for the enzyme determination in stools from patients suspected of having a pancreas insufficiency of exocrine nature. The median value of 353 fecal chymotrypsin determination of 180 normal persons was 137 mug/g of native stool. There is a good correlation in comparing the fecal with the duodenal chymotrypsin: Out of 30 comparable patients, 10 patients had pathological values for the duodenal and fecal chymotrypsin determinations, whereas 18 patients had normal values. According to the results of the pancreozymin-secretin-test, false normal stool results were recorded for two patients. No false positive stool values were recorded for the comparative collective. The great accuracy, the modest instrumental expense and the negligible inconvenience for the patient are good in line with the requirements for a screening test.

Topics: Acute Disease; Anilides; Cholecystokinin; Chronic Disease; Chymotrypsin; Diagnosis, Differential; Duodenum; Evaluation Studies as Topic; False Negative Reactions; False Positive Reactions; Feces; Humans; Indicators and Reagents; Intestinal Secretions; Pancreatic Diseases; Phenylalanine; Recurrence; Secretin

The effect of intramuscular chimotripsin on the levels of methicillin and tetracycline administered respectively intramuscularly and orally was studied in patients with chronic pneumonia and in experimental rats. It was found that the dose of chimotripsin providing higher methicillin blood levels was many times lower than the enzyme doses providing analogous indices for the blood serum and organs of the rats. When the patients were treated with tetracycline and chimotripsin, increased blood levels of the antibiotic were observed. Administration of chimotripsin to the rats had no effect on tetracycline pharmacokinetics in the animals.

Topics: Animals; Anti-Bacterial Agents; Biological Availability; Chronic Disease; Chymotrypsin; Drug Interactions; Humans; Kinetics; Methicillin; Pneumonia; Rats; Tetracycline; Time Factors

Topics: Animals; Calcium; Calculi; Chromatography, Gel; Chronic Disease; Chymotrypsin; Electrophoresis, Polyacrylamide Gel; Immunodiffusion; Immunoelectrophoresis; Lactoferrin; Lactoglobulins; Male; Molecular Weight; Pancreas; Pancreatitis; Potentiometry; Rabbits; Spectrophotometry, Ultraviolet

Topics: Adult; Aged; Chronic Disease; Chymotrypsin; Drug Evaluation; Female; Humans; Male; Middle Aged; Pneumonia; Trypsin

Topics: Chloramphenicol; Cholesteatoma; Chronic Disease; Chymotrypsin; Deoxyribonucleases; Drug Therapy, Combination; Erythromycin Ethylsuccinate; Humans; Hyaluronoglucosaminidase; Neomycin; Otitis Media; Streptomycin; Trypsin

Topics: Acute Disease; Amylases; Bicarbonates; Chronic Disease; Chymotrypsin; Humans; Pancreas; Pancreatic Hormones; Pancreatic Juice; Pancreatitis; Trypsin

Topics: Adolescent; Adult; Amylases; Bicarbonates; Cholecystokinin; Chronic Disease; Chymotrypsin; Clinical Enzyme Tests; Cobalt Radioisotopes; Diabetes Mellitus, Type 1; Female; Humans; Injections, Intravenous; Lipase; Male; Pancreatic Diseases; Pancreatitis; Proteins; Secretin; Trypsin; Vitamin B 12

Topics: Body Fluids; Chronic Disease; Chymotrypsin; Cobalt Radioisotopes; Duodenum; Humans; Intestinal Absorption; Pancreatitis; Trypsin; Vitamin B 12

Topics: Adult; Amylases; Bicarbonates; Cholecystokinin; Chronic Disease; Chymotrypsin; Cobalt Radioisotopes; Depression, Chemical; Duodenum; Female; Gastric Juice; Humans; Male; Pancreas; Pancreatitis; Secretin; Stimulation, Chemical; Time Factors; Trypsin; Vitamin B 12

An analysis of the plasma proteins in the sol phase of sputum was carried out using quantitative cross immunoelectrophoresis. The average concentrations of nine plasma proteins were estimated in the sol phase of sputum specimens from 30 patients with chronic bronchitis and the values were compared with the concentrations of these proteins in saliva and serum specimens from the same group of patients. The results showed that alpha(1) antichymotrypsin and IgA concentrations were higher in the sol phase of sputum than would be expected if their presence were due entirely to passive transudation.

Topics: alpha 1-Antitrypsin; Alpha-Globulins; Animals; Beta-Globulins; Blood Proteins; Bronchitis; Chronic Disease; Chymotrypsin; Female; Glycoproteins; Haptoglobins; Humans; Immunoelectrophoresis; Immunoglobulin A; Immunoglobulin G; Male; Middle Aged; Rabbits; Saliva; Serum Albumin; Sputum; Transferrin

Topics: Adult; Autonomic Nerve Block; Chronic Disease; Chymotrypsin; Female; Follow-Up Studies; Humans; Lumbar Vertebrae; Lumbosacral Plexus; Male; Middle Aged; Peptide Hydrolases; Procaine; Radiculopathy; Spinal Puncture

Topics: Amylases; Cholecystokinin; Chronic Disease; Chymotrypsin; Female; Humans; Lipase; Male; Pancreas; Pancreatic Juice; Pancreatic Neoplasms; Pancreatitis; Secretin; Stimulation, Chemical; Trypsin

Topics: Adult; Animals; Anti-Bacterial Agents; Chronic Disease; Chymotrypsin; Drug Therapy, Combination; Humans; Infusions, Parenteral; Injections, Intramuscular; Male; Middle Aged; Penicillin G; Pneumonia

Topics: Buffers; Chronic Disease; Chymotrypsin; Clinical Enzyme Tests; Feces; Humans; Indicators and Reagents; Methods; Pancreas; Pancreatic Diseases; Pancreatic Neoplasms; Pancreatitis; Postoperative Complications

Topics: Acute Disease; Adolescent; Aged; Brain; Chronic Disease; Chymotrypsin; Female; Humans; Intracranial Arteriosclerosis; Lipase; Male; Neurocognitive Disorders; Pancreatitis; Recurrence; Trypsin

Topics: Amylases; Cholecystokinin; Chronic Disease; Chymotrypsin; Clinical Enzyme Tests; Feces; Humans; Lipase; Pancreatic Diseases; Pancreatic Juice; Secretin; Secretory Rate; Stimulation, Chemical; Trypsin

Topics: Bronchitis; Chronic Disease; Chymotrypsin; Drug Combinations; Expectorants; Humans; Male; Oleandomycin; Piperazines; Tetracycline; Theophylline

Topics: Acetylcysteine; Chronic Disease; Chymotrypsin; Humans; Otitis; Otitis Media; Trypsin

Topics: Animals; Chronic Disease; Chymotrypsin; Dog Diseases; Dogs; Malabsorption Syndromes; Pancreas; Pancreatic Diseases; Trypsin

Sera from chronically uremic and normal individuals were subjected to gel filtration with Sephadex G-25 and the same fraction of both was infused into rats with a decreased nephron population to determine the effects on sodium excretion. Sodium excretion rate and fractional sodium excretion increased slightly with the normal fractions; but the increase in both functional parameters produced by the uremic fractions was substantially and significantly greater. The natriuresis could not be explained by associated changes in glomerular filtration rate (GFR), para-aminohippurate (PAH) clearance, filtration fraction, hematocrit, or blood pressure. The possibility thus exists that the inhibitor affected some component part of the transepithelial sodium transport system. The elution characteristics of the fraction plus certain of its physicochemical properties suggest that the inhibitor of sodium reabsorption by the rat nephron may be identical with the inhibitor of PAH uptake by kidney slices and the inhibitor of transepithelial sodium transport by the frog skin and toad bladder previously found in the serum of chronically uremic patients.

Topics: Adolescent; Adult; Aminohippuric Acids; Animals; Anura; Biological Assay; Blood; Chronic Disease; Chymotrypsin; Female; Glomerular Filtration Rate; Humans; Inulin; Kidney Tubules; Middle Aged; Natriuresis; Pronase; Rats; Skin Absorption; Uremia; Urinary Bladder

Topics: Acute Disease; Adolescent; Adult; Aged; Chronic Disease; Chymotrypsin; Female; Heparin; Humans; Leg; Lymphedema; Male; Middle Aged; Thrombophlebitis; Trypsin

Topics: Adolescent; Adult; Chemical Phenomena; Chemistry; Chloramphenicol; Chronic Disease; Chymotrypsin; Costs and Cost Analysis; Female; Hospitalization; Humans; Length of Stay; Pelvic Inflammatory Disease; Physical Therapy Modalities; Prednisone

Topics: Acute Disease; Adult; Aged; Bicarbonates; Cholecystokinin; Chronic Disease; Chymotrypsin; Female; Food; Humans; Male; Methods; Middle Aged; Pancreas; Pancreatic Diseases; Pancreatic Juice; Secretin

Topics: Acute Disease; Adult; Amylases; Chronic Disease; Chymotrypsin; Female; Humans; Male; Methods; Middle Aged; Pancreatic Juice; Pancreatitis; Trypsin

Topics: Adolescent; Adult; Aerosols; Aged; Asthma; Bronchiectasis; Bronchitis; Chronic Disease; Chymotrypsin; Deoxyribonucleases; Female; Humans; Injections, Intramuscular; Lung Abscess; Male; Middle Aged; Pulmonary Fibrosis; Ribonucleases; Trypsin

Topics: Adolescent; Adult; Chronic Disease; Chymotrypsin; Drug Combinations; Female; Humans; Male; Middle Aged; Neomycin; Periodontitis; Prednisolone; Subgingival Curettage; Trypsin

Topics: Amylases; Angiography; Bicarbonates; Cholecystokinin; Chronic Disease; Chymotrypsin; Duodenum; Germany, West; Humans; Intestinal Secretions; Lipase; Pancreatitis; Secretin; Trypsin

Topics: Acetylcysteine; Aniline Compounds; Asthma; Bronchitis; Chronic Disease; Chymotrypsin; Expectorants; Humans; Oxytetracycline; Sputum; Toluene

Topics: Blood Glucose; Blood Proteins; Cholesterol; Chronic Disease; Chymotrypsin; Ear, Middle; Galactosamine; Glucose; Glycosaminoglycans; Hearing Disorders; Hexosamines; Humans; Hydrogen-Ion Concentration; Mucus; Otitis Media; Proteins; Trypsin; Water

Topics: Age Factors; Chronic Disease; Chymotrypsin; Ethanol; Feces; Humans; Microscopy, Electron; Pancreatitis; Recurrence; Regeneration; Time Factors; Vascular Diseases

Topics: Anti-Bacterial Agents; Chronic Disease; Chymotrypsin; Drug Synergism; Humans; Maxillary Sinus; Sinusitis; Solutions; Therapeutic Irrigation

Topics: Adult; Aged; Celiac Artery; Chronic Disease; Chymotrypsin; Cysts; Diagnosis, Differential; Hemoperitoneum; Humans; Male; Middle Aged; Necrosis; Pancreatic Elastase; Pancreatitis; Radiography; Spleen; Splenic Artery; Splenic Diseases; Splenic Rupture

Topics: Amylases; Chronic Disease; Chymotrypsin; Cytodiagnosis; Diet Therapy; Duodenum; Feces; Humans; Intestinal Secretions; Pain; Pancreatin; Pancreatitis; Radiography; Radionuclide Imaging; Tolbutamide

Topics: Adult; Aged; Bronchial Diseases; Chronic Disease; Chymotrypsin; Female; Humans; Male; Middle Aged; Respiratory Function Tests; Tetracycline; Trypsin

Topics: Amylases; Anemia; Body Weight; Carboxypeptidases; Child, Preschool; Chronic Disease; Chymotrypsin; Diet Therapy; Duodenum; Edema; Exocrine Glands; Feces; Female; Growth Disorders; Humans; Hypoproteinemia; Intestinal Secretions; Lipase; Lipid Metabolism, Inborn Errors; Lipids; Metabolism, Inborn Errors; Nitrogen; Pancreas; Pancreatin; Psychomotor Disorders; Trypsin

Topics: Acute Disease; Amylases; Chronic Disease; Chymotrypsin; Diagnosis, Differential; Feces; Gastric Juice; Humans; Lipase; Lipids; Pancreatic Diseases; Pancreatic Neoplasms; Pancreatitis; Preoperative Care; Trypsin

Topics: Acute Disease; Adult; Alcoholism; Amylases; Chronic Disease; Chymotrypsin; Clinical Enzyme Tests; Crohn Disease; Diagnosis, Differential; Feces; Humans; Male; Pancreas; Pancreatitis

Topics: Adult; Amylases; Bicarbonates; Carboxypeptidases; Cholecystokinin; Chronic Disease; Chymotrypsin; Diagnosis, Differential; Diet Therapy; Female; Humans; Injections, Intravenous; Lipase; Male; Middle Aged; Pancreas; Pancreatitis; Secretin; Secretory Rate; Trypsin

Topics: Celiac Disease; Chronic Disease; Chymotrypsin; Diagnosis, Differential; Feces; Glucose Tolerance Test; Humans; Internal Medicine; Pancreatic Diseases; Pancreatitis; Radiography

Topics: Adhesives; Chronic Disease; Chymotrypsin; Drug Therapy; Hematologic Tests; Humans; Otitis Media; Prednisolone

Topics: Chronic Disease; Chymotrypsin; Drug Therapy; Humans; Sinusitis; Toxicology

Topics: Adhesives; Chronic Disease; Chymotrypsin; Hematologic Tests; Humans; Otitis Media; Tissue Adhesions

Topics: Anti-Bacterial Agents; Antibiotics, Antitubercular; Antigens; Antigens, Bacterial; Asthma; Bronchitis; Chloramphenicol; Chronic Disease; Chymotrypsin; Demeclocycline; Drug Resistance, Microbial; Enterobacter aerogenes; Erythromycin; Humans; Isoproterenol; Penicillin Resistance; Penicillins; Sputum; Staphylococcus; Streptomycin; Sulfisoxazole; Tetracycline

Topics: Bacitracin; Child; Chronic Disease; Chymotrypsin; Humans; Otitis Media; Polymyxins; Trypsin

Topics: Chronic Disease; Chymotrypsin; Hematologic Tests; Humans; Sinusitis

Topics: Anti-Bacterial Agents; Chronic Disease; Chymotrypsin; Humans; Maxillary Sinusitis; Paranasal Sinuses; Sinusitis; Therapeutic Irrigation